Nurse practitioners and physician assistants can alleviate some of the primary care shortage facing the United States, but their scope-of-practice is limited by state regulation. This study reports both cross-sectional and longitudinal trends in state scope-of-practice regulations for nurse practitioners and physician assistants over a 10-year period. Regulations from 2001 to 2010 were compiled and described with respect to entry-to-practice standards, physician involvement in treatment/diagnosis, prescriptive authority, and controlled substances. Findings indicate that most states loosened regulations, granting greater autonomy to nurse practitioners and physician assistants, particularly with respect to prescriptive authority and physician involvement in treatment and diagnosis. Many states also increased barriers to entry, requiring high levels of education before entering practice. Knowledge of state trends in nurse practitioner and physician assistant regulation should inform current efforts to standardize scope-of-practice nationally.
Abstract Many states allow nurse practitioners (NPs) to practice and prescribe drugs without physician oversight, increasing the number of autonomous primary care providers. We estimate the causal impact of NP independence on population health care utilization rates and health outcomes, exploiting variation in the timing of state law passage. We find that NP independence increases the frequency of routine checkups, improves care quality, and decreases emergency room use by patients with ambulato...
Abstract Background It is widely recognized that there is significant state-level variation in scope-of-practice regulations (SSoPRs) for nurse practitioners (NPs). Purpose This study was designed to examine whether SSoPRs influence labor markets for NPs. Method Cross-sectional analysis examining how SSoPRs influence the number and growth in NPs; data from the Area Resource File and 2008 Pearson report were used. Discussion Restrictive SSoPRs reduced the number of NPs by about 10 per 100,000 and...
#1Jingping Xing(URMC: University of Rochester Medical Center)H-Index: 2
#2Dana B. Mukamel(UCI: University of California, Irvine)H-Index: 60
Last. Helena Temkin-Greener(URMC: University of Rochester Medical Center)H-Index: 29
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Objectives: To examine the incidence of, variations in, and costs of potentially avoidable hospitalizations (PAHs) of nursing home (NH) residents at the end of life and to identify the association between NH characteristics and a facility-level quality measure (QM) for PAH. Design: Retrospective. Setting: Hospitalizations originating from NHs. Participants: Long-term care NH residents who died in 2007. Measurements: A risk-adjusted QM was constructed for PAH. A Poisson regression model was used ...
The use of nurse practitioners (NPs) is one way to address the shortage of physician primary care providers. NP training programs and the number of practicing NPs have increased in the past two decades. However, regulations limiting their scope of practice vary greatly by state. We assessed the impact of state regulations on the increase in care provided by NPs in the United States, using a 5 percent national sample of Medicare beneficiaries. We found that between 1998 and 2010 the number of Med...
#1Mary Halter(St George's, University of London)H-Index: 17
#2Vari Drennan(St George's, University of London)H-Index: 27
Last. Robert Grant(St George's, University of London)H-Index: 23
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Background Primary care provision is important in the delivery of health care but many countries face primary care workforce challenges. Increasing demand, enlarged workloads, and current and anticipated physician shortages in many countries have led to the introduction of mid-level professionals, such as Physician Assistants (PAs). Objective: This systematic review aimed to appraise the evidence of the contribution of PAs within primary care, defined for this study as general practice, relevant...
Impending physician shortages in the United States will necessitate greater reliance on physician assistants and nurse practitioners, particularly in primary care. But how willing are Americans to accept that change? This study examines provider preferences from patients’ perspective, using data from the Association of American Medical Colleges’ Consumer Survey. We found that about half of the respondents preferred to have a physician as their primary care provider. However, when presented with ...
The purpose of this research was to examine factors associated with the use of advanced practice nurse and physician assistant (APN/PA) visits to nursing home (NH) patients compared with those by primary care physicians (PCPs). This was a secondary analysis using Medicare claims data. General estimation equations were used to determine the odds of NH residents receiving APN/PA visits. Ordinary least squares analyses were used to examine factors associated with these visits. A total of 5,436 APN/...
Shortages of primary care doctors are occurring globally; one means of meeting this demand has been the use of physician assistants (PAs). Introduced in the United States in the late 1960s to address doctor shortages, the PA movement has grown to over 75,000 providers in 2011 and spread to Australia, Canada, Great Britain, The Netherlands, Germany, Ghana, and South Africa. A purposeful literature review was undertaken to assess the contribution of PAs to primary care systems. Contemporary studie...
BACKGROUND: A current trend to address the increasing numbers of new graduate nurse practitioners (NPs) and the expanding scope of practice of NPs is the emergence of employer-based postgraduate NP residency/fellowship programs. PURPOSE: The purpose of this study was to conduct a comprehensive examination of postgraduate NP residency/fellowship programs in the United States, to gain an understanding of the facilitators, barriers, benefits, and funding of these programs, from the perspective of t...
Background null The misuse of opioids is a health crisis in the United States. Medication treatment for opioid use disorder reduces negative health outcomes, but there are widespread shortages of appropriately trained and credentialed providers. Advanced practice registered nurses (APRNs) have recently become eligible for Drug Enforcement Administration (DEA) waivers that allow them to prescribe the most common medication, buprenorphine, but many factors might constrain their full participation ...
ABSTRACT Background Nurse Practitioners have the potential to reduce primary care shortages for underserved populations. Yet, scopes of practice in some political jurisdictions (e.g. states, provinces) are more restrictive than others, and prevent Nurse Practitioners from working to the full extent of their training. The research is limited as to which intrastate or interstate characteristics contribute to understanding why scope of practice differences exist. Objectives To estimate associations...
Objective This study examined if the variation in physician assistant (PA) state scope of practice (SOP) laws across states are associated with number of employed PAs, PA demographics and PA/population ratio per state. The hypothesis was that less restrictive SOP laws will increase the demand for PAs and the number of PAs in a state. Design Retrospective cross-sectional analysis at three time points: 1998, 2008, 2017. Setting Fifty states and the District of Columbia. Participants Employed PAs i...
Abstract Background: Despite the growing involvement of nurse practitioners in mental health services for children and adolescents, little is known about the patterns of mental health service use among youths treated by nurse practitioners compared to those by physicians. Objectives: To identify new users of psychotropic medications initiated by nurse practitioners and physicians among Medicaid-insured youths and to assess if receiving psychosocial services prior to or concurrent with medication...
#1Nicole Huang(UTMB: University of Texas Medical Branch)H-Index: 1
#2Mukaila A. Raji(UTMB: University of Texas Medical Branch)H-Index: 33
Last. Yong Fang Kuo(UTMB: University of Texas Medical Branch)H-Index: 71
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The objective was to examine trend and care quality outcomes associated with nurse practitioner (NP) involvement in Accountable Care Organizations (ACOs) via a cross-sectional study of 521 Medicare...
BACKGROUND There is limited knowledge on the extent physicians delegate cosmetic procedures to midlevel providers. OBJECTIVE To assess dermatology and plastic surgery practice patterns for the injections of neurotoxins and dermal fillers. MATERIALS AND METHODS Four hundred ninety-two dermatology and plastic surgery practices were identified from 10 major US metropolitan areas. These practices were contacted, and staff were asked a series of questions to best characterize the practice patterns in...
Advanced care practitioners are a group of medical professionals, including physician assistants and nurse practitioners who assume similar roles in healthcare delivery. Certified registered nurse anesthetists, also advanced care practitioners, receive specialized training in anesthesia. Although the models of education are different, evidence supports that advanced care providers deliver high-quality, safe, collaborative care. The scope of practice for advanced care practitioner is governed by ...
BACKGROUND: The number of physician assistants (PAs) and advanced practice registered nurses (APRNs), together known as advanced practice providers (APPs), has risen dramatically. The goal is identifying characteristics of paid medical malpractice claims, in which APPs are defendants. METHODS: Retrospective cohort study using Harvard's malpractice insurer's national database. Closed claims (2007-2016) with PAs, APRNs, or physicians as defendants. The primary analysis compared claims by role grou...
#1Hyunjung Lee(ORISE: Oak Ridge Institute for Science and Education)H-Index: 4
#2Ashley H. Hirai(Health Resources and Services Administration)H-Index: 8
Last. John E. Snyder(Health Resources and Services Administration)H-Index: 7
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Background Rural health disparities and access gaps may contribute to higher maternal and infant morbidity and mortality. Understanding and addressing access barriers for specialty women’s health services is important in mitigating risks for adverse childbirth events. The objective of this study was to investigate rural-urban differences in health care access for women of reproductive age by examining differences in past-year provider visit rates by provider type, and quantifying the contributin...
