Waivers to Allow PAs and NPs to Prescribe Buprenorphine Vary by State

MedicalResearch.com Interview with:

Joanne Spetz, PhDProfessorPhilip R. Lee Institute for Health Policy StudiesSan Francisco, CA 94143-0936

Dr. Spetz

Joanne Spetz, PhD
Professor
Philip R. Lee Institute for Health Policy Studies
San Francisco, CA 94143-0936 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Medication treatment is an important component of treatment for opioid use disorder. Buprenorphine has been the focus of policies designed to increase access to treatment and is the most widely-used medication due to well-established evidence of its efficacy and its accessibility outside licensed narcotics treatment programs. The most common brand name for this medication is Suboxone.

There is a shortage of providers authorized to prescribe it, in part because only physicians were permitted to obtain waivers from the Drug Enforcement Agency to prescribe it outside of licensed narcotics treatment programs until the opioid bill of 2016. That bill granted nurse practitioners (NPs) and physician assistants (PAs) the ability to apply for waivers. However, in states that require NPs and/or PAs to be supervised by or collaborate with a physician, there are additional requirements regarding the training of the physician before the NP or PA can apply for a waiver. This affects nearly half of states for NPs, and all states for PAs.

We found that the average percentage of NPs with waivers was 5.6% in states that do not require physician supervision, but only 2.4% in more restrictive states. Even after adjusting for other factors, we found that the percentage of NPs with waivers was 75% higher when physician oversight is not required. We didn’t find a similar result for PAs, probably because they must have physician oversight in all states.  Continue reading

More Nurse Practitioners in Rural Areas Help Offset Primary Care Shortage

MedicalResearch.com Interview with:

Ying Xue, DNSc, RN Associate Professor University of Rochester School of Nursing Rochester NY 14642

Dr. Ying Xue

Ying Xue, DNSc, RN
Associate Professor
University of Rochester School of Nursing
Rochester NY 14642

MedicalResearch.com: What is the background for this study?

Response: Shortages of primary care physicians have been a national concern, and forecasts project worsening trends in the future.1 The shortfall of primary care physicians is particularly severe in rural and other underserved communities, and some evidence indicates that the shortage of primary care physicians is due to maldistribution rather than insufficient supply.2

Nurse practitioners (NPs) constitute the largest and fastest growing group of non-physician primary care providers. The Health Resources and Services Administration (HRSA) estimated that the number of primary care NPs will grow 93% from 2013 to 2025, and a projected shortage of 23,640 full-time equivalent primary care physicians in 2025 could be effectively mitigated with better utilization of NPs and physician assistants.1

As the primary care physician shortage persists, examination of trends in the distribution of primary care NP supply, particularly in relation to populations most in need, will inform strategies to strengthen primary care capacity. However, such evidence is limited, particularly in combination with physician workforce trends. We thus characterized the temporal trends in the distribution of primary care NPs in low-income and rural areas compared with the distribution of primary care physicians. Continue reading

Coordinated Care Program For Dementia Patients Reduced Need For Nursing Home Placement

MedicalResearch.com Interview with:

Lee A. Jennings, MD, MSHS Assistant Professor of Medicine Director, Oklahoma Healthy Aging Initiative Reynolds Department of Geriatric Medicine University of Oklahoma Health Sciences Center Oklahoma City, OK 73117

Dr. Jennings

Lee A. Jennings, MD, MSHS
Assistant Professor of Medicine
Director, Oklahoma Healthy Aging Initiative
Reynolds Department of Geriatric Medicine
University of Oklahoma Health Sciences Center
Oklahoma City, OK 73117

MedicalResearch.com: What is the background for this study?

Response: The research study focused on a novel model of care for persons living with Alzheimer’s disease and other types of dementia, the UCLA Alzheimer’s and Dementia Care Program. In the program, people with dementia and their caregivers meet with a nurse practitioner specializing in dementia care for a 90-minute in-person assessment and then receive a personalized dementia care plan that addresses the medical, mental health and social needs of both people. The nurse practitioners work collaboratively with the patient’s primary care provider and specialist physicians to implement the care plan, including adjustments as needs change over time.

The research was designed to evaluate the costs of administering the program, as well as the health care services used by program participants, including hospitalizations, emergency room visits, hospital readmissions and long-term nursing home placement. A total of 1,083 Medicare beneficiaries with dementia were enrolled in the program and were followed for three years. The study compared them to a similar group of patients living in the same ZIP codes who did not participate in the program. Continue reading

Physician Assistants and Nurse Practitioners Are Increasingly Providing Specialty Care

MedicalResearch.com Interview with:

Kristin Ray, MD, MS</strong> Assistant Professor Health Policy Institute University of Pittsburgh School of Medicine

Dr. Ray

Kristin Ray, MD, MS
Assistant Professor
Health Policy Institute
University of Pittsburgh School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We were interested in understanding how nurse practitioners and physician assistants are working with specialist physicians to provide specialty care. Much has been described and studied about nurse practitioners and physician assistants providing primary care, but the literature about their role in specialty care is more sparse. There have been many concerns over time about the supply of specialist physicians, heightening our interest in the role of nurse practitioners and physician assistants in working with specialist physicians.

We focused on examining whether care to physician specialist’s patients by nurse practitioners and physician assistants has increased over time as well as examining characteristics of patients seen by nurse practitioners and physician assistants.

We found that visits with NPs and PAs for specialty care have increased over time, but remains a small fraction of specialty care overall.

Continue reading

Physicians, PAs and Nurse Practitioners Provide Similar Amount of Low Value Care

MedicalResearch.com Interview with:

John N. Mafi, MD, MPH Division of General Internal Medicine and Health Services Research Department of Medicine, Ronald Reagan UCLA Medical Center Los Angeles, CA

Dr. John N. Mafi

John N. Mafi, MD, MPH
Division of General Internal Medicine and Health Services Research
Department of Medicine, Ronald Reagan UCLA Medical Center
Los Angeles, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our country has a primary care physician shortage. Some have advocated that we expand the scope of practice for nurse practitioners and physician assistants to help alleviate this problem and improve access to primary care. But a 2013 study in the New England Journal of Medicine found that a large number of physicians believed that nurse practitioners provided lower value care when compared with physicians. We decided to put that belief to the test. We studied 29,000 U.S. patients who saw either a nurse practitioner, physician assistant, or physician in the primary care setting for common conditions, and we compared the rate of low-value or unnecessary services—for example, unnecessary antibiotics for the common cold, or MRI for low back pain, or a CT scan for headache. Things that don’t help patients and may harm.

We found no difference in the rates of low value services between nurse practitioners, physician assistants, and physicians. In other words, they did equivalent amounts of inappropriate or bad care.

Continue reading

Follow Your Heart Program Reduced Hospital Readmissions Following Heart Surgery

Michael H. Hall, MD North Shore-LIJ Health SystemMedicalResearch.com Interview with:
Michael H. Hall, MD
North Shore-LIJ Health System

MedicalResearch: What are the key points of your research?

Dr. Hall: Our study was designed to improve care transition from the hospital to home after coronary bypass surgery. The innovative program (Follow Your Heart), implemented at one of our system hospitals, involves sending cardiac surgery nurse practitioners (NPs) who cared for the patients in the hospital to the homes of discharged patients for at least two visits in the first two weeks after discharge. Their goal is to provide continuity of care for patients that they know from the hospital setting and to provide robust medication management, coordinate community services, and be a communications hub for hospital and community providers (primary care, cardiology, and community nurse home visit services). The  nurse practitioners interact with community resources to ensure understanding and satisfaction of the patients’ needs prior to hand-off to those resources after two weeks. Our  nurse practitioners utilize encrypted smart phones to provide reports to all appropriate providers and can even send pictures of incisions to the surgeon when necessary.

Continue reading