Nurse practitioners and primary care

Both Health Affairs and the New York Times (in the Fixes blog) are talking about a greater use of nurse practitioners in health care.

From the Health Affairs blog:

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines policy proposals that would allow nurse practitioners to practice to their full potential–and the extent to which the medical profession, policy makers, and patients are supportive of that effort.

Currently, about 55 million Americans live in areas with shortages of primary health professionals, a situation that may grow worse as the Affordable Care Act increases access to insurance coverage and the population ages and chronic illness increases in prevalence.

In nineteen US jurisdictions (eighteen states plus the District of Columbia), nurse practitioners–registered nurses who have also completed a postgraduate nursing degree–are allowed to diagnose and treat patients and prescribe medications without a physician’s involvement. These practitioners and their capabilities help to fill the void left by the current shortage in some parts of the country of primary care physicians. There is also a growing body of research showing that patients value access to consistent care from one particular provider, whether a nurse or a physician.

Read more here.

From Fixes at the New York Times:

The Family Health Clinic of Carroll County, in Delphi, Ind., and its smaller sibling about 40 minutes away in Monon provide full-service health care for about 10,000 people a year, most of them farmers or employees of the local pork production plant. About half the patients are Hispanic but there are also many German Baptist Brethren. Most of the patients are uninsured, and pay according to their income — the vast majority paying the $20 minimum charge for an appointment. About 30 percent are on Medicaid. The clinics, which are part of Purdue University’s School of Nursing, offer family care, pediatrics, mental health and pregnancy care. Many patients come in for chronic problems: obesity, diabetes, hypertension, depression, alcoholism.

What these clinics don’t offer are doctors. They are two of around 250 health clinics across America run completely by nurse practitioners: nurses with a master’s degree that includes two or three years of advanced training in diagnosing and treating disease. By 2015, nurse practitioners will be required to have a doctorate of nursing practice, which means two or three more years of study. Nurse practitioners do everything primary care doctors do, including prescribing, although some states require that a physician provide review.  Like doctors, of course, nurse practitioners refer patients to specialists or a hospital when needed.

Read the complete post here.

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