• Evaluation of the care rendered by advanced practice nurses and nurse managed clinics within the Army Health Care Organization

      Davis, Laurie Jeanne; Mills, Mary Etta C. (1995)
      The purpose of this study was to compare the quality of care rendered in a nurse managed clinic (NMC) by advanced practice nurses (APNs) to care rendered in the more traditional physician managed clinics (PMCs) by either APNs or physicians. Client satisfaction was measured as an indicator of service quality. Donabedian's structure, process and outcome model was used as the framework. Variables from all three components were assessed. Two separate questionnaires were administered to a convenience sample of 173 women receiving their well woman care at an Army community hospital in Virginia. The sample consisted of 56 clients of APNs in a NMC, 56 clients of APNs in a PMC and 61 physician clients. The average age of the sample was 35 with a range of 18 to 74. A modified version of SERVQUAL was used to measure the outcome variable of satisfaction with additional items added to measure selected structural and process variables. One open ended question was added to allow clients to elaborate on likes and dislikes of the various clinics and providers under study. Expectations of care were assessed prior to a well woman health care appointment and perceptions of care immediately following the appointment. Both scores were used for computation of the satisfaction score. Findings suggested that the clinic structure but not type of provider, was correlated to the client's intent to return, their perception of convenience and their perception regarding the adequacy of time allocated to teaching. Significantly better ratings regarding all three perceptions were received from clients of the NMC. Multiple regression analysis suggested that convenience and adequacy of time spent on teaching were predictive of satisfaction. Open ended responses illustrated the importance of both time and humanness in regards to the clients perception of service quality. Clients wanted adequate time allocated for the appointment in order for questions to be answered and humane and individualized care delivered. This study's findings support increased utilization of NMCs and APNs in the Army and point to the importance of convenience and adequacy of appointment time. Further investigation into process of care differences and cost effectiveness is recommended.