Patient satisfaction with an advanced nurse practitioner (ANP) integrated community chest pain clinic
Authors: Ingram S , O'sullivan K , O'donnell S 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Martha McMenamin Scholarship, small grant awarded

Background
Patient presentations with chest pain to the Emergency Department (ED) account for 9% of ED attendances. In the primary care setting chest pain is a common presenting complaint with an over diagnosis/suspicion of stable angina, however General Practitioners (GPs) lack access to a cardiac specialist in a timely fashion. As a result 31% of all ED chest pain patients are referred by GPs. The innovative integrated community chest pain clinic (ICCPC) commenced in September 2020. This Advanced Nurse Practitioner (ANP) led clinic aims to provide an alternative avenue to which GPs can directly refer patients with non-acute chest pain, thereby shifting the focus of care from the acute hospital environment

Purpose
Integrated community based care and ANP led care are new phenomena to the Irish patient. This paper explores patient satisfaction with the ANP led integrated community chest pain clinic

Method
This quantitative descriptive study invited participation from ICCPC patients over a six-month period (N=177). The questionnaire was adapted from Cross et al, (2010). Return of the anonymous questionnaire was by freepost/Qualtrics. Ratings were based on a five-point scale from ‘Poor’ to ‘Excellent’. Satisfaction and experience of ANP led community care was evaluated and satisfaction with appointment scheduling, waiting times, service provision and follow-up care was measured. Quantitative data were analysed using descriptive statistics. A combination of ‘good’ very good’ and ‘excellent’ are taken to mean a positive rating. Ethical approval was granted by the hospital ethics committee.

Results
A response rate of 43.5% (n=77) was achieved, including female (55.2%) white Irish (85.1%) and age range 50–69 yrs (53%). Confidence in the level of assessment by the ANP received a 100% (n=77) positive rating. All responders felt safe in the clinic 100% (n=74). Appointment waiting times received positive ratings: GP to ICCPC waiting times 98% (74/75); referral from ICCPC to hospital for stress test 92% (35/38); and 94.3% (50/53) positive rating regarding waiting times for phone-reported test results. Suggestions for improvements included the need for clearer signage/easier access to the ICCPC and a preference for follow-up check-ups by the ICCPC. If discharged for hospital follow up some wished for clearer follow-on care plans from the hospital.

Conclusion and Implications
This study suggests that the ANP led integrated community chest pain clinic plays a crucial role in meeting the needs of integrated patient centred care. The ANP led clinic was well received by patients and is a blueprint for other community initiatives. Many positive comments were included, with one participant stating "this service should be in every community, I think this would encourage people to go to the GP about mild chest pain without the fear of being sent to ED".