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Easing restrictions on NPs helps primary care shortage

Sunday July 14, 2013
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States with the fewest restrictions on nurse practitioners’ scope of practice had 2.5 times more patients receiving primary care from NPs than did the most restrictive states, according to a study.

Facing a nationwide shortage of primary care physicians, some states in recent years have eased up on regulations that create barriers for NPs who want to work as primary care providers, according to the study, which was published in the July issue of the journal Health Affairs.

"We wanted to look at what happened in states that allowed nurse practitioners more or less authority," the study’s lead author, Yong-Fang Kuo, PhD, of the University of Texas Medical Branch at Galveston, said in a news release. "As you would expect, it makes a big difference. We can now clearly show that states with fewer regulations means more patients get the primary care they need."

The UTMB study looked at the growth in care provided by NPs from 1998 to 2010 using state records and national Medicare data. The researchers found that the number of Medicare patients nationwide seeing NPs as their primary care provider increased from 0.2% in 1998 to 2.9% in 2010. (In Alaska, the rate was nearly 15%.)

Over the 12-year time period studied, the highest growth in NP primary care was in states that allowed them to practice and prescribe independently: Alabama, Alaska, Idaho, Montana, New Hampshire, New Mexico, North Dakota, Maine, Oregon and Vermont.

"Relaxing state restrictions on NP practice should increase the use of NPs as primary care providers, which in turn would reduce the current national shortage of primary care providers," the authors concluded.

Increasing access to primary care is a key focus of national health reform efforts. States with a higher ratio of primary care providers to patients have lower Medicare expenditures and lower mortality rates, according to the researchers.

The shortage in primary care physicians has happened in part because more and more U.S. medical students are choosing medical specialty fields instead of primary care. Fewer than 25% of U.S. medical students choose careers in primary care today, compared with about 60% in 1998, according to the news release.

Nurse practitioner programs have increased in the past two decades, according to the release, with more NPs in the U.S. than ever before. In some states, NPs and physicians have essentially the same authority to practice. Other states require physician supervision and limit nurse practitioners’ hospital privileges and authority to order tests, make referrals and prescribe medications.

Read the study abstract: http://content.healthaffairs.org/content/32/7/1236.abstract?=right.


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