Advanced practice nurses led clinic in a psychiatric hospital: An outcome evaluation in Singapore

Abstract

BackgroundAgeing population and rising patients' expectations, coupled with the shortage of physicians and the increasing pressure to contain health care costs, have resulted in rapid growth of advanced practice nurses (APNs), and the gradual shift of care from physicians to them. Though it was reported that APNs can provide safe, effective and quality care for patients, the evidence in mental health is lacking both locally and internationally. ObjectivesThis study evaluated the effectiveness of mental health APN-led clinic through examining the participants' clinical outcomes, satisfaction and perceived recovery. MethodsPre-post test study design was used, whereby 100 participants were surveyed by questionnaires, in addition to retrospective review of participants' medical records. Comparison was made from data obtained two years prior to and two years after participant's first consultation with APNs. ResultsParticipants had their psychiatric symptoms well-controlled (M = 24.71, SD = 1.18). There was no significant difference in readmissions (p = 0.320) and the emergency room visits (p = 0.320) over two years before and two years after participants' first consultation with APNs. However, there was a significant difference in default rates (p = 0.020). Participants seen by APNs had better attendance for their appointments than those seen by doctors. Participants reported being satisfied with APNs (M = 121.07, SD = 10.82), had good adherence to medications (M = 7.26, SD = 2.42), good perception of mental health recovery (M = 94.43, SD = 12.53) and had confidence in achieving their goals (M = 31.44, SD = 5.78). Characteristics of participants were not correlated with outcomes, with exception that age was correlated to drug adherence (p < 0.001). Satisfaction with APNs was also noted to correlate with mental health recovery (p < 0.001) and general self-efficacy (p < 0.001). ConclusionThis study supported the evidence that mental health advanced practice nurses can provide safe, effective and quality care for patients.