Advanced Practice Nurses: Improving
Access to Health Care for Coloradans
The need for primary care in the U.S.
As the
American population ages and more citizens have access to obtain health
insurance it is unclear how the existing population of practitioners can meet
this increasing demand. In a recent
Federal Trade Commission (FTC) study it was determined that the U.S. faces a
growing shortage of primary care physicians which will reduce access for our
poorest citizens, including Medicare beneficiaries and those who live in rural
communities (1). The National Governor’s Association (NGA)
determined that by the year 2019, the demand for primary care in the U.S. will
increase by between 15 and 25 million visits per year requiring 4,000 to 7,000
more physicians to meet this demand (2).
Colorado’s need: The Colorado Health Access
Survey conducted by the Colorado Health Institute (2013)
·
14.3% are uninsured
·
9.3%
are Medicare beneficiaries
·
7.3%
are Medicaid recipients
·
15%
indicate they are unable to obtain an appointment as timely as their perceived
need
·
8.2%
experience providers that do not accept their insurance
·
8.4%
have been told by practices that they are not accepting new patients
·
54.1%
reported using an E.D. for their last visit because an office visit was not
available as timely as their perceived need
·
50-100%
of primary care is provided by NP’s in 4 Colorado counties and 25-50% in an
additional 18 Colorado counties (3)
The Solution
Advanced
Practice Registered Nurses (APRN’s) including Nurse Practitioners (NP’s) are a
key strategy to alleviate provider shortages in primary care in medically
underserved areas and for medically underserved populations. Fortunately, the number of APRN’s per capita
grew an average of more than 9% annually between the mid 1990’s and mid 2000’s
compared to a 1% annual growth of primary care physicians (PCP’s) during the
same time (1). The
APRN solution to increase access to care has been endorsed by:
·
The
Federal Trade Commission Policy Perspectives: Competition and Regulations of
Advanced Practice Nurses (2014; 1)
·
The NGA; The Role of Nurse Practitioners in
Meeting Increasing Demand for Primary Care (2012; 2)
·
The
Institute of Medicine National Academy of Sciences, The Future of Nursing: Leading Change, Advancing Health (2011; 4)
·
The
RAND Health Report Submitted to the Commonwealth of Massachusetts (2009, 5)
·
The
Kaiser Family Foundation; Improving Access to Adult Primary Care in Medicaid
(2011, 6)
·
The
Robert Wood Johnson Foundation; How Nurses are Solving Some of Primary Care’s
Most Pressing Challenges (2012, 7)
Colorado’s next steps
After the
sun downing of the Nurse Practice Act in 2008, the Nurse Physician Advisory
Taskforce for Colorado Healthcare (NPATCH) was formed to make recommendations
for policy making entities (8).
NPATCH determined that APRN’s in Colorado may receive full prescriptive
authority only after completing
1. An initial 1800 hour preceptor ship
to obtain Provisional Prescriptive Authority –and
2. An 1800 hour mentorship and one time
articulation plan signed by a physician within 5 years
No other
state has this requirement in place (9). An unintended
consequence of this regulation is that many APRN’s are not able to find
physician mentors, are unable to find employment and are therefore moving out
of the state of Colorado where there are less restrictive oversight
requirements (8).
Constrained
supervision requirements in the state of Colorado will result in decreasing the
pool of available APRN’s to provide access to care for vulnerable populations
in the state seeking primary care services.
(1)
Federal Trade Commission (2014). Policy
Perspectives: Competition and Regulations of Advanced Practice Nurses. Available at: http://www.ftc.gov/reports/policy-perpectives-competition-regulation-advanced-practice-nurses
(2)
National Governor’s Association, NGA
Paper: The Role of Nurse Practitioners in
Meeting Increasing Demand for Primary Care (2012), http://www.nga.org/files/live/sites/NGA/files/pdf/1212NursePractitionersPaper.pdf
(3)
Colorado Health Access Survey
(2013), Courtesy of the Colorado Health
Institute, www.ColoradoHealthInstitute.org/health/colorado-health-access-survey-1
(4)
Institute of Medicine, National
Academy of Sciences, The Future of Nursing: Leading Change,
Advancing Health (2011).
(5)
Christine E. Eibner, et al., RAND
Health Report Submitted to the Commonwealth of Massachusetts, Controlling Health Care Spending in
Massachusetts: An Analysis of Options (2009),
http://www.ran.org/content/dam/rand/pubs/technical_reports/2009/RAND_TR733.pdf.
(6)
Kaiser Family Foundation, Improving Access to Adult Primary Care in
Medicaid: Exploring the Potential Role
of Nurse Practitioners and Physician Assistants (March 2011), http://kaiserfamilyfoundaton.files.wordpress.com/2013/01/8167.pdf
(7)
Robert Wood Johnson Foundation, How Nurses are Solving Some of Primary
Care’s Most Pressing Challenges (2012), http://www.rwjf.org/content/dam/files/rwjf-web-files/Resources/2/cnf20120810.pdf.
(8)
Hoback, J. (2014). ‘Unfettered
nursing’ required for Coloradans desperate for care. http://www.healthnewscolorado.org/2014/02/26/unfettered-nursing-required-for-coloradans-desperate-for-care/
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