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University of Texas Medical Branch study explores NP regulations

Monday August 5, 2013
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According to a new study by researchers at the University of Texas Medical Branch at Galveston, states with the fewest restrictions on nurse practitioners’ scope of practice had two-and-a-half times more patients receiving primary care from nurse practitioners than did the most restrictive states.

"We wanted to look at what happened in states that allowed nurse practitioners more or less authority," Yong-Fang Kuo, PhD, lead author of the study, 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 nurse practitioners from 1998 to 2010 using state records and national Medicare data. The researchers found that the number of patients seeing nurse practitioners as their primary care provider is on the upswing. In 1998, only 0.2% of Medicare patients nationwide used nurse practitioners as their primary care provider, versus 2.9% in 2010, according to the release.

Over the 12-year period studied, the highest growth in nurse practitioner 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.

The study was funded by the Agency for Healthcare Research and Quality, among others, and appears in the July issue of the journal Health Affairs.

In related news, State Senate Bill 406, which eases regulations on both nurse practitioners and physician assistants, was approved by the Texas Legislature and signed by the governor. The legislation, scheduled to go into effect Nov. 1, eliminates the requirement for on-site physician supervision and allows physicians to delegate drug and durable medical device prescribing authority to an advanced practice RN or physician’s assistant. It also increases the number of APRNs or PAs to whom a physician can delegate prescriptive authority and allows physicians to delegate prescribing authority to APRNs and PAs for Schedule II controlled substances in hospitals and hospice settings. The legislation also aims to improve coordination between the Texas Medical Board and the Board of Nursing and Board of Physician Assistants.


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