If Canada’s health care system is to operate at optimal efficiency without compromising on patient quality and access to care, reconfiguring the infrastructure of team-based health care will be at the heart of its transformation. Expanding the scope of practice of non-physician health care professionals, such as nurse practitioners and pharmacists, is a practical solution to the ever-evolving, increasingly complex needs of patient groups and communities, as well rising health care costs. These changes will inevitably lead to vast improvements in care quality and efficiency, as well as greater fiscal sustainability.
EXPANDED SCOPES OF PRACTICE IN CANADA
Expanded scope of practice (SoP) applies to health care professionals who take on a wider range of tasks that would be considered outside their traditional scope of practice. Two prominent Canadian examples of this are pharmacists and nurse practitioners. Although varying task authorizations exist across different Provinces, pharmacists are now able to initiate prescriptions for minor ailments and conditions, as well as inject drug, influenza, and travel vaccines, order and interpret lab tests, and adapt or change dosing for Schedule 1 drugs. Notably, Alberta is a leading example in regards to pharmacists’ expanded roles, having already approved and implemented every new scope of practice across the Province, while many others are still pending legislation and policy changes to accommodate implementation.
Significant gains have also been made in solidifying the role of the Nurse Practitioner (NP) – assessing, diagnosing, treating, and monitoring a wide range of health problems using an evidence-based approach. With the creation of North America’s first Nurse Practitioner-led clinics (NPLC), Ontario is leading the charge, with 25 NPLCs, in providing thousands of people with evidence-based care, specifically in underserved rural communities.
These breakthroughs in expanded scopes of practice are now trickling into other health professions, such as registered nurses (RNs), and Registered Practical Nurses (RPNs). Across Canada, only 61% of RNs claim they practice at the full scope of their qualifications and potential, leaving much room for improvement towards better utilization of health care human resources, and delivering more efficient, accessible care for the patients who desperately need it.
ALLEVIATE RISING HEALTH CARE COSTS
According to a 2015 report by the Canadian Institute of Health Information (CIHI), Canada stands in 5th out of the 29 nations comprising the Organization for Economic Co-operation and Development (OECD), in overall health care expenditures. Totalling nearly 10.7% of GDP. Canada spends $4,569 per person on health care – a stark increase from the OECD average of $3,566 per person.
Canada’s traditional fee-for-service and global health care funding model was sufficient when majority of the services were done by physicians, however, alternative forms funding are necessary to facilitate changes occurring in provider infrastructure. Currently, 15.5% of Canada’s health care budget is allocated for physician fees, but, with focus shifting towards activity and quality-based funding models, this incentivizes collaboration among physicians and other health care professionals to achieve greater patient outcomes. Expanding scopes of practice for NPs and pharmacists, for example, help reduce health care costs by distributing work to more affordable practitioners. Nonphysician health professionals account for approximately 1.8% of total health expenditure per capita.
IMPROVES CARE AND WORKFLOW EFFICIENCIES
Collaborative care teams involving professionals with an expanded scope of practice have been found to deliver greater patient outcomes. The World Health Organization (WHO) defines collaborative care as multiple health workers from different professional backgrounds providing comprehensive services by working with patients to deliver the highest quality of care across settings. One review study found that having pharmacists integrated into the primary care team correlated with significant reductions in patients’ systolic blood pressure. Other sources report greater patient satisfaction as expanded scope of practices of NPs and pharmacists allow for more time for patient visits, otherwise described as “rushed” and/or “less frequent” when seen by a physician. Professionally, physicians reported having more job satisfaction with decreased workload. Non-physicians with an expanded scope of practice reported having a greater sense of influence over patients’ well-being.
Integrating non-physician health care professionals into the forefront of patient care has proven to enhance patients’ well-being and satisfaction with the health care system, as well as being a much-needed complement and support for physicians’ increasingly complex workflow. Further expanding their roles and jurisdictions will extend the reach and capacity of Canada’s health care system in a productive, and sustainable way.
- Canadian Institute for Health Information, Report: National Health Expenditure Trends, 1975-2015. October 2015. Retrieved from: https://www.cihi.ca/en/spending-and-health-workforce/spending/national-health-expenditure-trends
- Canadian Pharmacists Association. Pharmacists’ Scope of Practice in Canada. January 2016. Retrieved from: https://www.pharmacists.ca/pharmacy-in-canada/scope-of-practice-canada
- Registered Nurses Association of Ontario. Primary Care Nurse Task Force Report: Primary Solutions for Primary Care. 2012. Retrieved from: http://rnao.ca/sites/rnao-ca/files/Primary__Care_Report_2012.pdf
- Ministry of Health and Long-Term Care. Nurse Practitioner-Led Clinics. May 2015. Retrieved from: http://www.health.gov.on.ca/en/common/system/services/npc