Primary Health Care Research & Development


Cost effectiveness and outcomes of a nurse practitioner–paramedic–family physician model of care: the Long and Brier Islands study

Ruth Martin-Misenera1 c1, Barbara Downe-Wamboldta1, Ed Caina2 and Marilyn Girouarda3

a1 Dalhousie University School of Nursing, 5869 University Ave., Halifax, Nova Scotia, Canada B3H 3J5

a2 Department of Emergency Medicine, Dalhousie University, Nova Scotia, Canada

a3 Department of Emergency Health Services, Nova Scotia, Canada


Aim This longitudinal study was designed to address four research questions and the hypothesis; that adults living in a rural community receiving primary health care and emergency services from a team that included an on-site nurse practitioner (NP) and paramedics and an off-site family physician would, over time, demonstrate evidence of improved psychosocial adjustment and less expenditure of health care resources.

Background In Canada, there is a growing awareness and commitment to addressing the challenges of providing primary health care services in rural areas. A literature review supported the role of NPs in primary health care and a potential role for paramedics. No studies were found that evaluated the combination of NPs, paramedics and physicians as providers of primary health care.

Methods Structured questionnaires, individual and group interviews with patients, health and social service care providers and administrators and community members were used to describe and evaluate the impact of the model of care over the three years of the study.

Findings The innovative model of care resulted in decreased cost, increased access, a high level of acceptance and satisfaction and effective collaboration among care providers. Organizational structures to support the innovative model of primary health care were identified.

(Received April 16 2008)

(Accepted October 31 2008)


  • collaboration;
  • evaluation;
  • family physician;
  • innovation;
  • nurse practitioner;
  • paramedics;
  • primary health care;
  • rural health care


c1 Correspondence to: Dr Ruth Martin-Misener, Dalhousie University, School of Nursing, 5869 University Ave., Halifax, Nova Scotia, Canada B3H 3J5. Email: