Racial and ethnic disparities in ED use among older adults with asthma and primary care nurse practitioner work environments.

Background: Nurse practitioners (NPs) increasingly deliver primary care in the United States. Yet, poor working conditions strain NP care. We examined whether racial/ethnic health disparities in ED visits among older adults with asthma are moderated by primary care NP work environments. Methods: Survey data on NP work environments in six states were collected from 1,244 NPs in 2018-2019. 2018 Medicare claims data from 46,658 patients with asthma was merged with survey data to assess the associations of all-cause and ambulatory care sensitive conditions (ACSC) ED visits with NP work environment and race/ethnicity using logistic regression. Results: NP work environment moderated the association of race (Black patients versus White patients) with all-cause (odds ratio [OR]: 0.91; p-value = 0.045) and ACSC (OR: 0.90; p-value = 0.033) ED visits. Conclusions: Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with favorable NP work environments.

Systemic lupus erythematosus: a genetic review for advanced practice nurses.

PURPOSE: To review the symptom presentation, genetic aspects, and available treatment options for individuals diagnosed with systemic lupus erythematosus (SLE). Primary care providers should be vigilant in identifying symptoms, which may be related to SLE, perform adequate assessment, and diagnostic testing in order to arrive at an early diagnosis. DATA SOURCES: Extensive literature review of textbook, clinical, medical, and nursing journals. CONCLUSIONS: Lupus is a multigenic autoimmune disease, which requires the clinician to be hypervigilant by collecting a thorough family history and performing a complete physical assessment of the patient. There is an array of treatment modalities, both experimental and proven therapies, which improve signs and symptoms associated with SLE. Numerous medications are available for symptom management: anti-inflammatory agents for patients with musculoskeletal presentation, and steroids or antimalarials for those with more extensive organ involvement. IMPLICATIONS FOR PRACTICE: In SLE, the overall aim of management is to determine the extent of disease and prevent extensive organ involvement. Therefore, when diagnosed in a timely manner, most patients will survive and are able to manage their disease.