The impact of nurse practitioner regulations on population access to care

Neff, Donna Felber; Yoon, Seok Hwa; Steiner, Ruth; Bejleri, Ilir; Bumbach, Michael D.; Everhart, Damian; Harman, Jeffrey S.

doi:10.1016/j.outlook.2018.03.001

Cited by 28 publications

(29 citation statements)

References 26 publications

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“…Access to care was measured in various ways, for example, appointment availability, travel cost, having a usual source of care (Traczynski & Udalova, 2018), driving time to nearest primary care providers (Neff et al, 2018), number of retail clinic openings (Carthon et al, 2017), and the percentage of population in low-, medium-, and high-accessibility areas (Graves et al, 2016). Three studies reported significantly greater primary care access in states with FPA (Carthon et al, 2017; Neff et al, 2018; Traczynski & Udalova, 2018). One study (Graves et al, 2016) found little difference in the population share in low accessibility areas by level of state NP practice regulations, yet this difference was not statistically tested.…”

Section: Resultsmentioning

confidence: 99%

“…Access to Care. Access to care was measured in various ways, for example, appointment availability, travel cost, having a usual source of care (Traczynski & Udalova, 2018), driving time to nearest primary care providers (Neff et al, 2018), number of retail clinic openings (Carthon et al, 2017), and the percentage of population in low-, medium-, and high-accessibility areas (Graves et al, 2016). Three studies reported significantly greater primary care A significantly higher odds of physician referral in CHCs in states with FPA than in those without.…”

Section: Overall Resultsmentioning

confidence: 99%

“…access in states with FPA (Carthon et al, 2017;Neff et al, 2018;Traczynski & Udalova, 2018). One study (Graves et al, 2016) found little difference in the population share in low accessibility areas by level of state NP practice regulations, yet this difference was not statistically tested.…”

Section: N/d 4mentioning

confidence: 99%

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

et al. 2020

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There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforce, access to care, utilization, care quality, or cost of care), guided by Donabedian’s structure, process, and outcomes framework. This systematic review was performed using Medline, CINAHL, PsycINFO, and PubMed according to Preferred Reporting Items for Systematic and Meta-Analysis on the literature from January 2000 to August 2019. The results indicate that expanded state NP practice regulations were associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality. This evidence could provide guidance for policy makers in states with more restrictive NP practice regulations when they consider granting greater practice independence to NPs.

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Section: Resultsmentioning

confidence: 99%

Section: Overall Resultsmentioning

confidence: 99%

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

et al. 2020

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“…A profession's practice authority is related to the practitioners’ ability to practice across the full scope of their education and credentialing 12 . Increased practice authority for midwives and advanced practice nurses improves use of services and affects the size and demographics of the workforce without negatively impacting quality of care, thereby expanding client choice of practitioner and increasing access to care, particularly in medically underserved rural and urban areas 12‐18 …”

Section: State/ Territory Title Interconception Careb Oxytocin/pitocimentioning

confidence: 99%

Medication access and midwifery integration: An example of community midwifery advocacy for access in Washington State, USA

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et al. 2020

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“…Systematic reviews have found that states with full SOP policy have more and faster growth of NPs, greater likelihood of NPs caring for underserved populations, and improved utilization of services (Patel, Petermann, & Mark, 2018; Xue, Ye, Brewer, & Spetz, 2016). Less restrictive SOP is also associated with lower odds of having to drive over 30 min to a primary care provider (Neff et al, 2018), and greater supply of NPs in rural and primary care health professional shortage counties (Xue et al, 2018). One rigorously conducted study of states’ changing from restrictive to full SOP found increased consumer utilization of checkups, increased availability of appointments when wanted, more adults rating their health care as excellent, decreased emergency room visits for ambulatory care sensitive conditions, and decreased administrative burden for physicians (Traczynski & Udalova, 2018).…”

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confidence: 99%

Nurse Practitioner Scope of Practice: What Do We Know and Where Do We Go?

Mark

Patel

2019

West J Nurs Res

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There is no question that access to primary care is critical for population health. Currently, more than one in 10 U.S. residents resides in a county with fewer than one primary care physician per 2,000 people, and the demand for primary care will increase as the population grows and ages, chronic conditions increase, and insurance coverage expands (UnitedHealth Group, 2018). Lack of access to primary care contributes to an increase in avoidable suffering and wasted dollars, as people are forced to seek expensive emergency care or hospitalization after their often preventable health condition is too advanced to ignore (Rosano et al., 2013; Shi, 2012). The primary care workforce is also changing. Between 2010 and 2016, the physician workforce grew by 1.1% whereas the nurse practitioner (NP) workforce grew by 9.4%; these trends are projected to continue through 2030, with the availability of advanced practice providers predicted to outstrip the availability of physicians in primary care (Auerbach, Staiger, & Buerhaus, 2018). Between 2008 and 2016, the fraction of providers who were NPs in primary care practices grew by over 40%, whereas the fraction of providers who were physicians in these settings dropped by 12% (Barnes, Richards, McHugh, & Martsolf, 2018). Given this shift, it is increasingly important to understand how statelevel NP scope of practice (SOP) policies influence access to primary care.

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The impact of nurse practitioner regulations on population access to care

Cited by 28 publications

References 26 publications

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

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

Medication access and midwifery integration: An example of community midwifery advocacy for access in Washington State, USA

Nurse Practitioner Scope of Practice: What Do We Know and Where Do We Go?

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