Primary Care Nursing and Liver Management: A Qualitative Study from a Telemedicine Education Program (ECHO Ontario Liver)
Bibliographic record
Abstract
CONTEXT: Nursing primary care providers (PCPs) are well-positioned to address central gaps in screening, linkage to care, and treatment of liver diseases within their teams. The Extension for Community Healthcare Outcomes (ECHO) Model™ is a telementoring education program that connects PC providers from underserved areas to an interprofessional specialist team. Each session includes a didactic lecture and a patient case presentation. ECHO Ontario Liver launched in 2017 with the goal of disseminating hepatology best practices appropriate for PC and improving PC providers’ knowledge and self-efficacy. OBJECTIVE: This study aims to explore the impact of ECHO on nursing PCPs and their role in interprofessional liver care. STUDY DESIGN: We conducted a qualitative study with nursing PCPs who attended ECHO sessions from 2017 to 2021. Focus groups were conducted virtually, recorded, and transcribed. ANALYSIS: Transcripts were analyzed using thematic content analysis. Researchers met regularly to discuss themes until consensus was reached. SETTING: Ontario, Canada POPULATION STUDIED: Nursing professionals (nurse practitioners, NPs, registered nurses, RNs, and registered practical nurses, RPNs) INTERVENTION: ECHO Ontario Liver OUTCOME MEASURES: Focus group discussions explored PCPs’ experience in ECHO, their role in liver care management (interprofessional collaboration), and impact of ECHO on practice. RESULTS: Three focus groups were conducted between November 2021 and January 2022. Six participants were NPs, four were RNs, and one was a RPN. Six (55%) providers practiced in rural communities. All were female. Nursing PCPs involved in different levels of liver management were interviewed. They played active management roles from coordinating appointments to providing wraparound patient services. ECHO allowed participants to access specialty knowledge and education they did not receive in their training. Though PCPs practiced on a team, these individuals become the point person on their team to attend ECHO, gaining advanced training in this disease area. Participants also used the ECHO patient case presentation and recommendations as a means of advocating for care on their clinical teams. CONCLUSIONS: Nursing PCPs play a variety of roles within the management of liver disease on their clinical teams. ECHO Ontario Liver increased participants’ access to specialty liver knowledge and case presentations and recommendations were often used as a means of advocacy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.013 | 0.007 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".