Preparing a Realist Evaluation to Investigate the Impact of Privately Practising Nurse Practitioners on Patient Access to Care in Australia

Background : Evaluation of privately practising nurse practitioner (PPNP) services in Australia is an important issue, because the sustainability of viable health services requires that they are underpinned by sound research. As part of ongoing work in relation to the evaluation of PPNP services, the authors plan to use realist evaluation (RE) to explore, not only whether PPNP services increase patient’s access to care, but also the means by which they achieve (or do not achieve) this outcome. RE is a complex methodology and its application requires careful preparation. Objective : To present the application of the RE methodology to an evaluation of PPNP services of health care in Australia. Method : This paper explores the philosophical underpinnings of RE and articulates the steps taken in preparing to apply RE to an evaluation of PPNP services in Australia. Discussion : RE is a complex methodology to understand and apply. There is an absence of documented detail in terms of how to apply RE to ensure that the evaluation is truly ‘realist’. Yet making the choice to apply RE to evaluations of PPNP services in Australia and overseas holds many advantages, primarily because of RE’s emphasis upon the context in which health care is delivered and how and why the context relates to the outcomes produced. This paper will contribute to the emerging dialogue on how to apply RE to evaluations of health care and will assist those considering using RE.