Scope-of-practice laws and expanded health services: the case of underserved women and advanced cervical cancer diagnoses

Abstract

BackgroundUnderserved women (rural, minority or poor) are disproportionally diagnosed with late-stage cervical cancer, indicative of inadequate access to, and use of, preventative healthcare. The Institute of Medicine (IOM) has proposed that nurse practitioners (NP) can address provider shortages among underserved populations, but to reduce shortages, scope-of-practice laws that restrict the delivery of care, must be revised. We examined the IOM recommendation of NP expanded scope-of-practice laws on reducing the disparity of underserved women diagnosed with late-stage cervical cancer.MethodsWe examined the cohort of 10 673 women diagnosed with cervical cancer between 2010 and 2014 and reported to the Surveillance, Epidemiology and End Results cancer registry. We linked state-level laws regarding NP scope-of-practice to patients with cancer by their state of residence, diagnosis date and law enactment date. Hierarchical regression was used to explore NP full scope-of-practice law’s impact on late-stage cancer diagnoses considering the moderating effect of women living in medically underserved areas. We adjusted for known confounders available in this population-based data set.ResultsMedically underserved women living in states with laws that restrict NP full scope-of-practice are twofold more likely to be diagnosed with late-stage cancer; adjusted OR and 95% CI (OR 2.08, 95% CI 1.4 to 3.1). These disparities were not observed among underserved women living in areas with NP full scope-of-practice laws (OR 0.95, 95% CI 0.7 to 1.3).ConclusionsNP full scope-of-practice laws could provide a pragmatic and cost-effective solution to healthcare provider shortages associated with late stage of cervical cancer diagnoses among underserved women.

State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review

“…Three other studies focused on health status of a specific care domain (Alexander & Schnell, 2019; Grecu & Spector, 2019; Smith-Gagen et al, 2019). The researchers reported significant improvement in self-reported mental health status and a decrease in mental health (Alexander & Schnell, 2019) and opioid-related mortality rates (Grecu & Spector, 2019) after expansion of NP prescriptive authority.…”

“…However, expanded access to care under FPA also can generate associated costs, especially for chronic conditions wherein medication use may be accessed or restored through care provided by NPs for underserved populations (Grant et al, 2017). Although initial costs of accessing care can increase short-term costs by instituting preventive measures (e.g., improved diabetes care), in the long term, health care costs actually could be reduced, through prevention of adverse consequences from poorly managed chronic conditions (Smith-Gagen et al, 2019; Spetz et al, 2013).…”

“…Another systematic review of studies conducted through 2017 reported the positive impact of NP practice regulations, particularly on access to care (Patel et al, 2019). Many more recent studies have examined other health care delivery outcomes associated with scope of practice, including patient safety (Ladd et al, 2017), quality of care (Alexander & Schnell, 2019; Kurtzman et al, 2017; Perloff et al, 2017; Smith-Gagen et al, 2019), and health care costs (Knepper et al, 2015; Poghosyan et al, 2019; Timmons, 2017). The purpose of our systematic review was to synthesize this newer, more comprehensive evidence, in order to examine the effect of NP practice regulations on a broader array of U.S. health care delivery outcomes.…”

Delayed Cerebrospinal Fluid Rhinorrhea Associated With Ethmoidal Encephalocele After Resection of Remote Meningioma

“…Giant meningiomas and frontoethmoidal encephaloceles, while certainly recognized throughout the world, are each relatively uncommon entities in their own right [1][2][3]11,12]. In underserved areas, both diagnostic and treatment delays may result in an increase in late-stage disease rates [6][7][8][9][10]. CSF leakage from long-silent encephaloceles is also a known phenomenon [12][13][14][15], but is usually preceded by polypectomy or biopsy of nasal mass [16].…”

“…Giant meningiomas (>5cm in diameter) are less common but may be more likely to be encountered in medically underserved areas due to lack of available resources for diagnosis or treatment, and a general trend of cultural mistrust of medical providers. Studies of racial, ethnic, and socioeconomic disparities within the United States found that minority populations and those in rural areas presented more often with advanced stages of tumor progression [6,7] or a later stage of disease in cancer cases [8][9][10].…”