Rural And Nonrural Primary Care Physician Practices Increasingly Rely On Nurse Practitioners

Abstract

The use of nurse practitioners (NPs) in primary care is one way to address growing patient demand and improve care delivery. However, little is known about trends in NP presence in primary care practices, or about how state policies such as scope-of-practice laws and expansion of eligibility for Medicaid may encourage or inhibit the use of NPs. We found increasing NP presence in both rural and nonrural primary care practices in the period 2008-16. At the end of the period, NPs constituted 25.2 percent of providers in rural and 23.0 percent in nonrural practices, compared to 17.6 percent and 15.9 percent, respectively, in 2008. States with full scope-of-practice laws had the highest NP presence, but the fastest growth occurred in states with reduced and restricted scopes of practice. State Medicaid expansion status was not associated with greater NP presence. Overall, primary care practices are embracing interdisciplinary provider configurations, and including NPs as providers can strengthen health care delivery.

Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine

“…We categorized provider locations using the Rural-Urban Commuting Area (RUCA) code 17 corresponding to the ZIP Code of providers' DEA registration addresses. 18 The RUCA codes were aggregated into 4 categories using the primary digit as follows: urban (1,2,3), large rural (4,5,6), small rural (7,8,9), and isolated rural (10).…”

“…Nurse practitioners (NPs) and physician assistants (PAs) were the first providers other than physicians to be authorized to obtain a DEA waiver. Because NPs and PAs provide a significant proportion of primary care services to rural populations, who experience challenges in accessing MBT services, these providers are thought to be an important part of the solution to ensure access for underserved populations …”

“…in accessing MBT services, 6,7 these providers are thought to be an important part of the solution to ensure access for underserved populations. [8][9][10][11] Physicians have long reported barriers to providing buprenorphine services in their practices, [12][13][14][15][16] but little is known about the barriers NPs and PAs experience and whether they differ from those that physicians report. NPs and PAs practice under different scope-of-practice regulations in different states and with different levels of required practice supervision.…”

The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016

“…Our analysis supports these findings, with urbanity/density negatively associated with suicide and hunting license rate as a partial proxy for gun ownership positively associated with suicide. There is evidence that nurse NPs more likely to practice in rural areas than other types of providers, and it is possible that expanded NP scope of practice incentivizes practice in rural areas and leads to increased resources for mental health in primary care, psychiatry, community health, and other settings [48,49]. This pathway would explain our findings between full NP scope of practice and lower suicide rates.…”

Horizontal and vertical integration's role in meaningful use attestation over time

“…Data on ambulatory physicians were from a commercial research firm, SK&A, and included the years 2011, 2013, and 2015, with more than 500 000 physicians represented in each year of the data. SK&A aims to collect information on all office‐based physician practices in the United States via regularly scheduled phone interviews, and this data source has previously been used to measure physician EHR adoption, practice characteristics, and physician integration behavior . We used physician's national provider identifiers (NPIs) to combine these data with the Medicare MU Attestation Eligible Professionals Public Use Files (PUF) (https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/PUF.html) and the Medicare Provider Utilization and Payment Data.…”