Breaking News
June 20, 2018 - New approach could provide objective and easy-to-obtain measure of dietary adherence
June 20, 2018 - ‘Miracle treatment’ long-term success for babies with diabetes
June 20, 2018 - Rheumatoid Arthritis patients with depression have increased risk of disease flare
June 20, 2018 - NTU launches new research centers to prevent and treat diseases affecting Singaporeans
June 20, 2018 - Researchers examine risk factors for opioid dependence in patients undergoing surgery for DS
June 20, 2018 - Study finds substantial variation in cardiovascular risk across India
June 20, 2018 - Kidney donation among carefully-selected older adults poses minimal risks
June 20, 2018 - Effects of atrial fibrillation can be reduced or reversed by losing weight
June 20, 2018 - Allergan’s Oral CGRP Receptor Antagonist Atogepant Demonstrates Robust Efficacy and Safety in Episodic Migraine Prevention in a Phase 2b/3 Clinical Trial
June 20, 2018 - The novel insights of proteoglycans in mineralized tissues
June 20, 2018 - Scientists shed light on key aspect of healthy cell division
June 20, 2018 - Circulating bone turnover markers not linked to hip fracture risk, shows study
June 20, 2018 - Scientists obtain key information about proteins from single human cells
June 20, 2018 - Scientists identify novel genes linked with infantile forms of schizophrenia
June 20, 2018 - Low-dose aspirin could help pregnant women with high blood pressure avoid a dangerous condition
June 20, 2018 - Unusual gene provides novel insight into how the brain wires itself
June 20, 2018 - Study finds IV acetaminophen to be no more effective than oral counterpart for colectomy patients
June 20, 2018 - MAARA to celebrate its 50th anniversary with lecture titled ‘The Future of Asthma’
June 20, 2018 - Administration eases way for small businesses to buy insurance in bulk
June 20, 2018 - High-Quality Diet May Decrease Mortality Risk in Cancer Survivors
June 20, 2018 - JAMA editorial on ECG screening and cardiac risks
June 20, 2018 - Study hints at benefits of lifestyle interventions in reducing dementia risk
June 20, 2018 - Low blood levels of vitamin D linked to increased risk of interstitial lung disease
June 20, 2018 - Simple cognitive task after brain injury improves memory function, study finds
June 20, 2018 - Clinical trial targets metastatic colorectal cancer with new combination therapy
June 20, 2018 - Researchers discover pesticide-free way to limit mosquitoes and reduce spread of West Nile virus
June 20, 2018 - Persistent psychological stress contributes to development and progression of vision loss
June 20, 2018 - Study introduces novel strategy to obtain reasonable drug cost estimates for cost-effectiveness analyses
June 20, 2018 - Does Salt Water Help Your Cut? And Other Health Myths of Summer
June 20, 2018 - Scientists help identify genetic markers for prostate cancer in global DNA download
June 19, 2018 - Common ingredient in toothpaste and hand wash could contribute to antibiotic resistance
June 19, 2018 - WHO launches multiyear campaign to eliminate use of trans fat
June 19, 2018 - Scientists could build better drugs by learning from bacteria-derived molecules
June 19, 2018 - Comparative silence between firing spikes of neurons reveals what they are really up to
June 19, 2018 - JAK inhibitors associated with aggressive lymphoma
June 19, 2018 - SetPoint announces positive long-term results of bioelectronic medicine to treat rheumatoid arthritis
June 19, 2018 - Hypnosis may help reduce fear, anxiety in children undergoing treatment for cancer
June 19, 2018 - Scientists point to potentially promising treatment target for deadly brain cancers
June 19, 2018 - After opioid overdose, only 30 percent get medicine to treat addiction
June 19, 2018 - Patients with mild Alzheimer’s disease over age 65 continue to derive benefit from DBS-f treatment
June 19, 2018 - Microbiotica partners with University of Adelaide to develop defined bacterial product for ulcerative colitis
June 19, 2018 - Paratek Presents New Analysis from Combined Phase 3 Skin Infection Studies Highlighting Efficacy of Omadacycline in Treating Drug Resistant S. aureus
June 19, 2018 - Autism is not linked to eating fish in pregnacy
June 19, 2018 - Scientists create universal assembly method to enhance cancer therapy and diagnostics
June 19, 2018 - Follow-up study confirms success of physiological test for autism
June 19, 2018 - FDA provides guidance on Novus Therapeutics’ development path for OP-02 to treat otitis media
June 19, 2018 - Scientists discover new mechanism controlling multiple sclerosis risk
June 19, 2018 - Award granted to Neem Biotech to develop antimicrobial intervention for chronic lung infections
June 19, 2018 - Study finds combined risk of death and developing cancer to be lowest in light drinkers
June 19, 2018 - Novel app teaches users how to stop life-threatening bleeding and save lives
June 19, 2018 - Single blood sample can provide adequate confirmation of diabetes
June 19, 2018 - New stimulation method increases hope for improving disorders of consciousness
June 19, 2018 - FDA Issues Complete Response Letter for Duobrii (halobetasol propionate and tazarotene) Lotion
June 19, 2018 - Defining the biology of autism
June 19, 2018 - Researchers use optogenetics to shape tissues
June 19, 2018 - Scientists discover genetic causes underlying group of related infant cancers
June 19, 2018 - Innovative digital home testing kit benefits patients with kidney conditions
June 19, 2018 - New guidance on selection and evaluation of wearable devices for use in regulatory clinical trials
June 19, 2018 - Researchers understand the role of brain’s ‘reward circuit’ in autism spectrum disorder
June 19, 2018 - Researchers propose new strategy to combat micro-pollutants in water
June 19, 2018 - Illicit Opioid Trade Up With Restrictions on Hydrocodone
June 19, 2018 - New 3-D imaging analysis technique could lead to improved arthritis treatment
June 19, 2018 - Study finds increased risk of mortality in people with cold agglutinin disease in five years after diagnosis
June 19, 2018 - Psychologists can play important role in treating alcohol problems
June 19, 2018 - Study finds elevated risk of congenital defects in lithium-exposed infants
June 19, 2018 - Test-Taking Can Be Tough for Kids With Vision Problems
June 19, 2018 - Injections for knee osteoarthritis—’subtle but significant’ impact of revisions in clinical practice guidelines
June 19, 2018 - Researchers develop new approach to assess effectiveness of Men B vaccine
June 19, 2018 - Study shows link between financial literacy and hospitalization risk in older adults
June 19, 2018 - If you’ve got hep C, spitting can be a felony
June 19, 2018 - New study examines how the brain plays role in rheumatoid arthritis inflammation
June 19, 2018 - Researchers discover new defense mechanism against oxygen radicals
June 19, 2018 - WVU researcher aims to produce updated whooping cough vaccine
June 19, 2018 - Scientists develop novel computational framework to support personalized cancer treatment
June 19, 2018 - Rate of dementia on the decline—but beware of growing numbers
June 19, 2018 - Microglia play protective role in response to retinal detachment, shows study
June 19, 2018 - Technology breakthrough could enable detection of fetal genetic abnormalities in early pregnancy
June 19, 2018 - Novel chip can be used to identify rhinovirus strains as cause of asthma
June 19, 2018 - Effects of in vitro fertilization depend on genetic variation inherited from parents
June 19, 2018 - Heart attack patients unable to resume work report depression and financial hardship
Research highlights major role of nurse practitioners in rural areas

Research highlights major role of nurse practitioners in rural areas

image_pdfDownload PDFimage_print

Primary care is a critical piece of the healthcare puzzle because, for many people, it is the first point of contact with the healthcare system. Primary care is the early line of defense for screenings for major health conditions. Primary care providers also help patients with chronic conditions manage their disease and improve quality of life.

Despite the critical importance of primary care physicians (PCPs), the United States is facing a shortage of those doctors. The number of up-and-coming PCPs is nowhere close to the amount who are late in their careers or retiring. This shortage creates a challenge for some urban and rural areas, where primary care physicians are notoriously harder to recruit.

A key way to combat this shortage is to tap highly skilled nurse practitioners (NPs), who are choosing primary care at a much higher rate than physicians. Of the 248,000 NPs in the country, about 87 percent are trained in primary care and more are in the pipeline.

The University of Delaware’s Hilary Barnes, an assistant professor in the College of Health Sciences’ School of Nursing, recently published a research article in Health Affairs about primary care’s increased reliance in nurse practitioners in rural and nonrural areas. They now account for 1 in 4 medical care providers in practices in rural areas – a 43.2 percent increase overall from 2008 to 2016.

However, legislation in many states does not permit nurse practitioners to fully serve as primary care providers. Barnes is studying state-specific legislation on NP’s scope of practice, which vary greatly.

“Some states are very restrictive,” Barnes said. “An NP has to maintain written agreements with a physician to practice and prescribe medication. In the most extreme examples, the law states that an NP must talk about every patient with a physician. Or that the physician has to sign for prescriptions.”

States with restrictions at the highest level include Pennsylvania. Such regulations are challenging given the dwindling number of physicians in the field, and those rules also greatly undervalue an NPs’ ability deliver primary care safely and at a high level, Barnes described.

Barnes also pointed to what she described as “mid-level” states regarding regulation (including New Jersey), which provided additional latitude, but not autonomy for NPs.

“There’s an in-between where an NP needs a collaborative agreement to prescribe medication,” Barnes said. “The provider can practice independently of a physician, but, without prescriptive authority, you are limited on the services that you can provide to patients.”

Barnes said that at the fully autonomous level, such as Delaware, states allow NPs to practice primary care without supervision of a physician. In 2015, UD’s STAR Health Sciences Complex played host to the signing of a pair of Senate bills – SB57 and SB101 – that give Delaware advance practice nurses more independence. Through these and similar laws, NPs are nationally certified and can practice independently -; known as full practice authority.

Not surprisingly, states with more modern laws have more NPs providing primary care services to residents.

“In the states with more restrictive laws, say you are a trained NP in a rural area who wants to practice primary care,” Barnes said. “Because there is no physician in town, you can’t have a collaborative agreement. Therefore, you can’t practice at the advanced practice level. Or, say you live in Mansfield, Pennsylvania; you might have to sign a collaborative agreement with a physician in Harrisburg -; a two and half hour drive.”

If the physician collaborator moves away or retires, the NP loses the ability to practice. Additionally, more research is needed, but anecdotal evidence suggests that many NPs have to pay physicians to sign a collaborative agreement.

Evidenced-based research has shown that more restrictive laws don’t improve patients care.

Barnes added, “In states where the restrictions have been removed, care has not diminished. These restrictive laws don’t do anything to improve patient safety or quality of care. All that they are really doing is putting up barriers to primary care. Removing the practice restrictions can really only be a benefit.”

States like Pennsylvania are currently evaluating proposed legislation to reduce restrictions, including NPs becoming independent primary care providers after a certain number of hours under a primary care physician.

“These transition-to-practice hours are kind of a compromise,” Barnes said. “You are supervised by a physician for two or three years, an arbitrary number, before you can become independent. These laws are new, so we don’t have data on whether they are helpful or not. But, on the surface, they seem like another restriction.”

Employment of advanced practice clinicians

Barnes and several collaborators recently published a research study in JAMA Internal Medicine entitled “Employment of Advanced Practice Clinicians in Physician Practices.” The researchers investigated levels of and changes in advanced practice clinician employment across different physician practices -; comparing 2008 and 2016. Advanced practice clinicians include physician assistants and NPs.

The study paid particular attention to specialty practices, finding that approximately one in four specialty practices employ advanced practice clinicians (compared with one in three primary care practices). Historically, the NP role was developed to focus on primary care; most advanced practice clinicians are NPs. Hence, the expectation is that advanced practice clinicians would have a greater presence in primary care practices. Yet, the proportion of practices with advanced practice clinicians grew modestly over the past eight years.

This sort of shows the growing willingness/interest/importance of NPs to all segments of healthcare delivery – more practices are hiring them and using them to deliver care.

“We concluded that overall growth may be driven by number of factors,” Barnes said. “Factors include recent increases in graduates from advanced practice clinician programs, the emergence of value-based purchasing models that incentivize team-based care and downward price pressure from public and private payers, which makes the lower costs of advanced practice clinician employment more attractive.”

Tagged with:

About author

Related Articles