Breaking News
October 20, 2018 - Molecule capable of halting and reverting neurodegeneration caused by Parkinson’s disease identified
October 20, 2018 - Midazolam-mediated alterations of PER2 expression may have functional consequences during myocardial ischemia
October 20, 2018 - Sweat bees are ideal for studying the genes underlying social behavior
October 20, 2018 - Weight loss success associated with brain areas involved in self-control
October 20, 2018 - KHN’s ‘What the Health?’ Republicans’ preexisting political problem
October 20, 2018 - Research provides a more complete picture of suffering caused by terrorist attacks
October 20, 2018 - Eradicating Helicobacter pylori infections may be a key treatment for Parkinson’s disease
October 20, 2018 - Breast Cancer as a Dynamic Disease
October 20, 2018 - University of Pittsburgh wins NSF grant for big data research to prevent complications from anesthesia
October 20, 2018 - Skin-to-skin contact may promote attachment between parents and preterm infants
October 20, 2018 - Recommendations Developed to Verify NGT Placement in Children
October 20, 2018 - Weight loss can be boosted fivefold thanks to novel mental imagery technique
October 20, 2018 - Children with autism are more likely to be overweight, obese
October 20, 2018 - Nurses making conscientious objections to ethically-relevant policies lack support
October 20, 2018 - Prion strain diversity may be greater than previously thought
October 20, 2018 - Antidepressant treatment may lead to improvements in sleep quality of patients with depression
October 20, 2018 - Study reports increased risk of death in children with inflammatory bowel disease
October 20, 2018 - Number of Autism Genes Now Tops 100
October 20, 2018 - Total diet replacement programmes are effective for treating obesity
October 20, 2018 - CLARIOstar used for fluorescence measurements on CSIRO’s purpose-built research vessel
October 20, 2018 - People with more copies of AMY1 gene digest starchy carbohydrates faster
October 20, 2018 - Case Comprehensive Cancer Center wins NIH grant to study health disparities
October 20, 2018 - Newly discovered compound shows potential for treating Parkinson’s disease
October 20, 2018 - High rate of non-adherence to hormonal therapy found among premenopausal early breast cancer patients
October 20, 2018 - Immunotherapy medicine found to be effective in treating uveitis
October 20, 2018 - The Pistoia Alliance Calls for Greater Collaboration to Realise Benefits of Innovation and Announces Winners of the 2018 President’s Startup Challenge
October 20, 2018 - Female internists consistently earn less than men
October 20, 2018 - Stanford team looks at dangers of teens’ vaping habits
October 20, 2018 - New approach to understanding cancers will accelerate development of better treatments
October 20, 2018 - LJI and UC San Diego awarded $ 4.5 million as part of NCI’s Cancer Moonshot initiative
October 20, 2018 - School-based HPV vaccination did not increase risky sexual behaviors among adolescent girls
October 20, 2018 - Eye discovery to pave way for more successful corneal transplants
October 20, 2018 - New analysis examines the importance of location in the opioid crisis
October 20, 2018 - Green filters increase reading speed for children with dyslexia
October 19, 2018 - Bariatric Sx Cuts Macrovascular Complications in Obesity, T2DM
October 19, 2018 - Better assessments for early age-related macular degeneration
October 19, 2018 - Visible and valued: Stanford Medicine’s first-ever LGBTQ+ Forum | News Center
October 19, 2018 - Understanding of metal-free enzymes used by bacteria could lead to new effective antibiotics
October 19, 2018 - Beckman Coulter Life Sciences announces new research-focused website
October 19, 2018 - Study finds link between refined soluble fibers, gut microbiota and liver cancer
October 19, 2018 - Social media reduces risk of depression among seniors with pain
October 19, 2018 - Newly developed synthetic DNA molecule may one day be used as ‘vaccine’ for prostate cancer
October 19, 2018 - Preoperative weight loss may not provide health benefits after surgery
October 19, 2018 - U.S. Birth Rates Continue to Drop as Age of New Moms Rises
October 19, 2018 - New technology can keep an eye on babies’ movements in the womb
October 19, 2018 - Juul e-cigarettes pose addiction risk for young users | News Center
October 19, 2018 - Gene sequencing reveals crucial molecular aspects of Trypanosoma brucei
October 19, 2018 - New DNA vaccine strategy protects mice against lethal challenge by multiple H3N2 viruses
October 19, 2018 - Study shows close link between cytokine interleukin-1ß and obesity-promoted colon cancer
October 19, 2018 - Muscle mass plays a critical role in health, shows research
October 19, 2018 - Study finds undiagnosed prediabetes in many infertile men
October 19, 2018 - The Current issue of “The view from here” is concerned with Nanotherapeutic strategies
October 19, 2018 - Delay in replacing the Pap smear with HPV screening is costing lives
October 19, 2018 - Physicians battle pediatric diseases of ear, nose, throat in Zimbabwe | News Center
October 19, 2018 - Researchers investigate why some cancers affect only young women
October 19, 2018 - Drugmakers funnel millions to lawmakers; a few dozen get $100,000-plus
October 19, 2018 - Unselfish people tend to have more children and receive higher salaries
October 19, 2018 - New findings reveal potential cellular players in tumor microenvironment
October 19, 2018 - Study reveals impact of Juul use on teenagers and young adults
October 19, 2018 - Green leafy vegetables could help reduce macular degeneration risk
October 19, 2018 - Some countries take more time for reimbursement decisions on new cancer drugs
October 19, 2018 - Human brain cell transplant offers insights into neurological conditions
October 19, 2018 - Parental education associated with increased family health care spending
October 19, 2018 - New statistical method estimates long- and short-term risk of recurrence of breast cancer in US women
October 19, 2018 - Father’s exposure to nicotine may cause cognitive deficits in descendants
October 19, 2018 - Could we prevent Alzheimer’s disease by treating herpes?
October 19, 2018 - Nurse-led care can be more successful in managing gout
October 19, 2018 - Trump administration, pharma exchange verbal volleys on drug-price transparency
October 19, 2018 - Duke researchers find way to detect blood doping in athletes
October 19, 2018 - Many primary care doctors are still prescribing sedative drugs for older adults
October 19, 2018 - Finger length can predict sexuality in women say researchers
October 19, 2018 - Study finds differences in side-effects experienced by male and female OG cancer patients
October 19, 2018 - Dysfunction of single gene leads to miscarriages
October 19, 2018 - Few Seniors Who Self-Harm Referred for Mental Health Care
October 19, 2018 - Don’t sweat the sweet stuff
October 19, 2018 - URMC researchers discover new approach to deliver therapeutics to the brain
October 19, 2018 - Speech Pathology Australia raises awareness about Developmental Language Disorder
October 19, 2018 - Middlemen suppliers can increase drug prices and hospital bills, say Johns Hopkins researchers
October 19, 2018 - Survey finds high prevalence of HTLV-1 infection among teens and adults in Gabon
October 19, 2018 - Bliss funds research to find whether parental touch can help alleviate pain in premature infants
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