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Health Expect. 2017 Jan 10. doi: 10.1111/hex.12525. [Epub ahead of print]

Attending to power differentials: How NP-led group medical visits can influence the management of chronic conditions.

Author information

  • 1School of Nursing, University of British Columbia, Vancouver, BC, Canada.
  • 2CRiHHI: Critical Research in Health and Healthcare Inequities, University of British Columbia, Vancouver, BC, Canada.
  • 3Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada.
  • 4Department of Family Practice, Faculty of Medicine, Vancouver, BC, Canada.



In Canada, primary care reform has encouraged innovations, including nurse practitioners (NPs) and group medical visits (GMVs). NP-led GMVs provide an opportunity to examine barriers and enablers to implementing this innovation in primary care.


An instrumental case study design (n=3): two cases where NPs were using GMVs and one case where NPs were not using GMVs, was completed. In-depth interviews with patients and providers (N=24) and 10 hours of direct observation were completed. Interpretive descriptive methods were used to analyse data.


Two main themes were identified: (i) acquisition of knowledge and (ii) GMVs help shift relationships between patients and health-care providers. Participants discussed how patients and providers learn from one another to facilitate self-management of chronic conditions. They also discussed how the GMV shifts inherent power differentials between providers and between patients and providers.


NP-led GMVs are a method of care delivery that harness NPs' professional agency through increased leadership and interprofessional collaboration. GMVs also facilitate an environment that is patient-centred and interprofessional, providing patients with increased confidence to manage their chronic conditions. The GMV provides the opportunity to meet both team-based and patient-centred health-care objectives and may disrupt inherent power differentials that exist in primary care.


chronic disease; diffusion of innovation; group medical visits; nurse practitioner; power; quality of care

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