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1.
J Clin Nurs ; 29(1-2): 152-162, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31610060

RESUMO

AIMS AND OBJECTIVES: To describe the prescribing behaviours and practices of registered nurse and midwife prescribers and to explore experiences of enablers and barriers to prescribing practices. BACKGROUND: The extension of prescriptive authority to nurses and midwives internationally has created new opportunities for them to expand their scope of practice and is of significant benefit to effective and efficient health service provision. DESIGN: Cross-sectional national survey of registered nurse and midwife prescribers. METHODS: Data were collected through an online survey between April-July 2018. A total of 84 nurse and midwife prescribers participated. The STROBE checklist was applied as the reporting guideline for this study. RESULTS: Respondents estimated that two-fifths of their consultations involved an episode of prescribing. Nurse and midwife prescribers engaged in similar prescribing behaviours spanning the range of activities from initiating new medications to ceasing medicines. The most frequently selected criterion for prescribing was clinical effectiveness. Prescribing was viewed as essential to respondents' clinical practice, allowing them to provide a complete episode of care and leading to a reduction in medication errors and reduced delays and waiting times for patients. Enablers of prescribing included knowledge, experience, education and access to continuous professional development, as well as support from colleagues and organisations. CONCLUSION: Little is known about the prescribing behaviours and practices of registered nurse and midwife prescribers. While prescribing authority enables nurse and midwife practitioners to deliver holistic care, there remain significant barriers and challenges including increased workloads, lack of continuous professional development, lack of support and overly restrictive rules and policies governing prescribing. RELEVANCE TO CLINICAL PRACTICE: Addressing the barriers identified in this study could enable more nurse and midwife prescribers to work to their full scope of practice, enabling populations to fully capitalise on the contributions of registered nurse and midwife prescribing services.


Assuntos
Prescrições de Medicamentos/enfermagem , Padrões de Prática em Enfermagem , Estudos Transversais , Prescrições de Medicamentos/estatística & dados numéricos , Cuidado Periódico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Gravidez , Inquéritos e Questionários
2.
Med Care ; 57(11): 905-912, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31568165

RESUMO

BACKGROUND: It is unclear whether Medicare data can be used to identify type and degree of collaboration between primary care providers (PCPs) [medical doctors (MDs), nurse practitioners, and physician assistants] in a team care model. METHODS: We surveyed 63 primary care practices in Texas and linked the survey results to 2015 100% Medicare data. We identified PCP dyads of 2 providers in Medicare data and compared the results to those from our survey. Sensitivity, specificity, and positive predictive value (PPV) of dyads in Medicare data at different threshold numbers of shared patients were reported. We also identified PCPs who work in the same practice by Social Network Analysis (SNA) of Medicare data and compared the results to the surveys. RESULTS: With a cutoff of sharing at least 30 patients, the sensitivity of identifying dyads was 27.8%, specificity was 91.7%, and PPV 72.2%. The PPV was higher for MD-nurse practitioner/physician assistant pairs (84.4%) than for MD-MD pairs (61.5%). At the same cutoff, 90% of PCPs identified in a practice from the survey were also identified by SNA in the corresponding practice. In 5 of 8 surveyed practices with at least 3 PCPs, about ≤20% PCPs identified in the practices by SNA of Medicare data were not identified in the survey. CONCLUSIONS: Medicare data can be used to identify shared care with low sensitivity and high PPV. Community discovery from Medicare data provided good agreement in identifying members of practices. Adapting network analyses in different contexts needs more validation studies.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Interpretação Estatística de Dados , Assistência à Saúde/métodos , Humanos , Colaboração Intersetorial , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Texas , Estados Unidos
3.
Nurs Outlook ; 67(6): 707-712, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607371

RESUMO

BACKGROUND: The research findings about nurse practitioner (NP) patient experiences (satisfaction) are limited to small sample sizes from local community clinics. No national studies with large sample sizes were found. PURPOSE: To analyze responses from the Consumer Assessment of Healthcare Providers and Systems survey and compare the patient experiences from four different provider categories. METHODS: Secondary data analysis was completed on survey responses from 53,885 patients. FINDINGS: In the sample, medical doctor providers were disproportionately represented in greater number than NPs, doctor of osteopathy, or physician assistant. Further analysis comparing patient experiences between providers revealed NP to be rated significantly higher than their colleagues. DISCUSSION: Recognizing the factors associated with patient satisfaction with their providers can lead to improvements in patient-provider interactions that can result in increased quality of care. CONCLUSION: Policy makers should find opportunities to employ NP in primary care settings and achieve greater patient satisfaction that can influence outcomes associated with patient-centered care initiatives.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Relações Enfermeiro-Paciente , Satisfação do Paciente/estatística & dados numéricos , Relações Médico-Paciente , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
4.
Iowa Orthop J ; 39(1): 211-216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413696

RESUMO

Background: Midlevel providers (i.e. physician assistants [PAs] and nurse practitioners [NPs]) are being integrated into systems of care due to the exponentially increasing demand for orthopaedic care. There is a lack of studies which investigate orthopaedic patients' perspectives regarding midlevel providers. Methods: An anonymous questionnaire was administered to 538 first-time patients of four orthopaedic surgeons before their new patient visit. Content included patient perspectives regarding: optimal scope of practice, midlevel provider importance in physician selection, and reimbursement equity with physicians. Results: Of 538 consecutive patients, 415 (77%) responded. 57% were female with an average age of 63.9 ± 11.4 years. Most patients (68%) considered the training background of the surgeon's midlevel provider when initially choosing an orthopaedic surgeon. 34% of all patients perceived PAs to be more highly trained than NPs while 17% perceived the opposite. Patients had specific preferences regarding which services should be surgeon-provided: follow-up for abnormal tests (82%), initial postoperative appointment (81%), new patient visits (81%), and determining the need for advanced diagnostic studies (e.g. MRI) (76%). Patients had specific preferences regarding which services could be midlevel-provided: preoperative teaching (73%), minor in-office procedures (65%), long term postoperative appointments (61%), and prescriptions (61%). Patients lacked a consensus on reimbursement equity for midlevel providers and orthopaedic surgeons, despite most patients (78%) reporting the surgeon provides a higher-quality consultation. Conclusions: As health care becomes increasingly consumer-centric and value-driven, a databased utilization of midlevel staff will allow orthopaedic physicians to optimize efficiency and patient satisfaction. Surgeons may consider our results in division of clinical duties among midlevel staff since patients had specific preferences regarding which services should be physician-provided or midlevel-provided. Orthopaedic surgeons may also consider including the midlevel provider in marketing efforts, as most patients considered the midlevel provider's training background when initially choosing a surgeon and perceived PAs to be more highly trained than NPs. Patients lacked a consensus towards reimbursement equity for orthopaedic surgeons and midlevels, despite reporting that the surgeon provides a higher quality consultation. These findings are important as the midlevel workforce grows in response to the rising demand for orthopaedic care.Level of Evidence: IV.


Assuntos
Competência Clínica , Profissionais de Enfermagem/estatística & dados numéricos , Cirurgiões Ortopédicos/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Preferência do Paciente , Inquéritos e Questionários , Estados Unidos
5.
J Clin Nurs ; 28(23-24): 4342-4356, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31318988

RESUMO

AIMS AND OBJECTIVES: In Canada, nurse practitioners (NP) were legally authorised to prescribe controlled drugs and substances (CDS) in 2012. The objective of this study was to understand current NP-CDS prescribing in Alberta, Manitoba and Saskatchewan, Canada. This study is a component of a larger three-phase survey of NP practice patterns in these same provinces. BACKGROUND: Nurse practitioners are nurses with a graduate degree who have the legal authority to perform expanded functions in health systems, including prescribing CDS. Given the novelty of CDS prescribing for NPs in Canada, little is known about this component of their role. DESIGN: A secondary analysis of survey data collected between March 2016 and May 2017 was used to examine NP-CDS-prescribing patterns and identify potential associated factors. METHODS: Nurse practitioners in Alberta, Manitoba and Saskatchewan were invited to complete a professional practice pattern survey. The survey was administered through a secure electronic data collection software application (redcap). In the practice pattern survey, 42 variables from 15 distinct conceptual questions were analysed in this study as potential predictors of NP-CDS prescribing within a purposeful selection ordinal logistic regression model. This scientific submission has been assessed for accuracy and completeness using the Equator STROBE guideline criteria (see Appendix S1). RESULTS/FINDINGS: Five variables were found to be associated with an increased odds of more frequent NP-CDS prescribing in addition to three confounders/clinically relevant variables. Factors commonly associated with an increased frequency of NP-CDS prescribing relate to location of practice, area of practice, previous nursing experience, team environments and common diagnoses. CONCLUSION: Little is known about NP-CDS prescribing. Understanding this important component of the NPs emerging legal scope of professional practice can contribute to the continued refinement of this role as well as support ongoing enquiry into the causes of, and potential interventions to prevent, the present opioid overdose deaths occurring while under an active prescription. RELEVANCE TO CLINICAL PRACTICE: Understanding factors that influence NP-CDS prescribing has relevance to the current drug-related prescription fatalities crisis in all countries.


Assuntos
Substâncias Controladas , Prescrições de Medicamentos/enfermagem , Profissionais de Enfermagem/estatística & dados numéricos , Padrões de Prática em Enfermagem , Adulto , Idoso , Canadá , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
6.
Health Serv Res ; 54(5): 1065-1074, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31264205

RESUMO

OBJECTIVE: To describe delivery of recommended HIV care and work satisfaction among infectious disease (ID) physicians, non-ID physicians, nurse practitioners (NPs), and physician assistants (PAs). DATA SOURCES: Medical Monitoring Project 2013-2014 HIV Provider Survey. STUDY DESIGN: Population-based complex sample survey. DATA COLLECTION/ANALYSIS METHODS: We surveyed 2208 HIV care providers at 505 US HIV care facilities and computed weighted percentages of provider characteristics, stratified by provider type. Rao-Scott chi-square tests and logistic regression used to compare characteristics of ID physicians with each other provider type. PRINCIPAL FINDINGS: The adjusted provider response rate was 64 percent. Among US HIV care providers, 45 percent were ID physicians, 35 percent non-ID physicians, 15 percent NPs, and 5 percent PAs. Satisfaction with administrative burden was lowest among non-ID physicians (27 percent). Compared with ID physicians, satisfaction with remuneration was lower among non-ID physicians and higher among NPs (37, 28, and 51 percent, respectively). NPs were more likely than ID physicians to report performing four of six services that are key to providing comprehensive HIV care, but more NPs planned to leave clinical practice within 5 years (19 vs 7 percent). CONCLUSION: Addressing physician dissatisfaction with remuneration and administrative burden could help prevent a provider shortage. Strengthening the role of NPs may help sustain a high-quality workforce.


Assuntos
Infecções por HIV/terapia , Mão de Obra em Saúde/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
7.
JAMA Netw Open ; 2(6): e196201, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31225894

RESUMO

Importance: There is new emphasis on clinician trust in health care organizations but little empirical data about the association of trust with clinician satisfaction and retention. Objective: To examine organizational characteristics associated with trust. Design, Setting, and Participants: This prospective cohort study uses data collected from 2012 to 2014 from 34 primary care practices employing physicians (family medicine and general internal medicine) and advanced practice clinicians (nurse practitioners and physician assistants) in the upper Midwest and East Coast of the United States as part of the Healthy Work Place randomized clinical trial. Analyses were performed from 2015 to 2016. Main Outcomes and Measures: Clinician trust was measured using a 5-item scale, including belonging, loyalty, safety focus, sense of trust, and responsibility to clinicians in need (range, 1-4, with 1 indicating low and 4 indicating high; Cronbach α = 0.77). Other metrics included work control, work atmosphere (calm to chaotic), organizational culture (cohesiveness, emphases on quality and communication, and values alignment; range, 1-4, with 1 indicating low and 4 indicating high), and clinician stress (range, 1-5, with 1 indicating low and 5 indicating high), satisfaction (range, 1-5, with 1 indicating low and 4 indicating high), burnout (range, 1-5, with 1 indicating no burnout and 5 indicating very high feeling of burnout), and intention to leave (range, 1-5, with 1 indicating no intention to leave and 5 indicating definite intention to leave). Analyses included 2-level hierarchical modeling controlling for age, sex, specialty, and clinician type. Cohen d effect sizes (ESs) were considered small at 0.20, moderate at 0.50, and large at 0.80 or more. Results: The study included 165 clinicians (mean [SD] age, 47.3 [9.2] years; 86 [52.1%] women). Of these, 143 (87.7%) were physicians and 22 (13.3%) were advanced practice clinicians; 105 clinicians (63.6%) worked in family medicine, and 60 clinicians (36.4%) worked in internal medicine. Compared with clinicians with low levels of trust, clinicians who reported high levels of trust had higher mean (SD) scores for work control (2.49 [0.52] vs 2.18 [0.45]; P < .001), cohesiveness (3.11 [0.46] vs 2.51 [0.51]; P < .001), emphasis on quality vs productivity (3.12 [0.48] vs 2.58 [0.41]; P < .001), emphasis on communication (3.39 [0.41] vs 3.01 [0.44]; P < .001), and values alignment (2.61 [0.59] vs 2.12 [0.52]; P < .001). Men were more likely than women to express loyalty (ES, 0.35; 95% CI, 0.05-0.66; P = .02) and high trust (ES, 0.31; 95% CI, 0.01-0.62; P = .04). Compared with clinicians with low trust at baseline, clinicians with high trust at baseline had a higher mean (SD) satisfaction score (3.99 [0.08] vs 3.51 [0.07]; P < .001; ES, 0.70; 95% CI, 0.39-1.02). Compared with clinicians in whom trust declined or remained low, clinicians with improved or stable high trust reported higher mean (SD) satisfaction (4.01 [0.07] vs 3.43 [0.06]; P < .001; ES, 0.98; 95% CI, 0.66-1.31) and lower stress (3.21 [0.09] vs 3.53 [0.09]; P = .02; ES, -0.39; 95% CI, -0.70 to -0.08) scores and had approximately half the odds of intending to leave (odds ratio, 0.481; 95% CI, 0.241-0.957; P = .04). Conclusions and Relevance: Addressing low levels of trust by improving work control and emphasizing quality, cohesion, communication, and values may improve clinician satisfaction, stress, and retention.


Assuntos
Pessoal de Saúde/psicologia , Organizações/normas , Atenção Primária à Saúde/normas , Confiança , Local de Trabalho/normas , Instituições de Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Comunicação , Eficiência Organizacional/estatística & dados numéricos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Medicina Interna/estatística & dados numéricos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/estatística & dados numéricos , Saúde do Trabalhador/normas , Saúde do Trabalhador/estatística & dados numéricos , Estresse Ocupacional/etiologia , Cultura Organizacional , Organizações/estatística & dados numéricos , Lealdade ao Trabalho , Assistentes Médicos/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional , Estudos Prospectivos , Responsabilidade Social , Estados Unidos , Carga de Trabalho/estatística & dados numéricos
8.
Nurs Outlook ; 67(6): 713-724, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31248627

RESUMO

BACKGROUND: Little is known about the extent of ordering low-value services by. PURPOSE: To compare the rates of low-value back images ordered by primary care physicians (PCMDs) and primary care nurse practitioners (PCNPs). METHOD: We used 2012 and 2013 Medicare Part B claims for all beneficiaries in 18 hospital referral ̱regions (HRRs) and a measure of low-value back imaging from Choosing Wisely. Models included random clinician effect and fixed effects for beneficiary age, disability, Elixhauser comorbidities, clinician sex, the emergency department setting, back pain visit volume, organization, and region (HRR). FINDINGS: PCNPs (N = 231) and PCMDs (N = 4,779) order low-value back images at similar rates (NP: all images: 26.5%; MRI/CT: 8.4%; MD: all images: 24.5%; MRI/CT: 7.7%), with no detectable significant difference when controlling for covariates. DISCUSSION: PCNPs and PCMDs order low-value back images at an effectively similar rate.


Assuntos
Dor nas Costas/diagnóstico por imagem , Diagnóstico por Imagem/economia , Diagnóstico por Imagem/estatística & dados numéricos , Medicare/economia , Profissionais de Enfermagem/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Atenção Primária à Saúde/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/economia , Estudos de Coortes , Feminino , Humanos , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
9.
J Surg Res ; 242: 252-257, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31103829

RESUMO

BACKGROUND: Mobile technology can aid in healthcare decision-making at the point of care. We created a Web-based trauma-specific smartphone application containing links to local protocols and national organization guidelines for trauma providers. We hypothesized that smartphone access to these guidelines would facilitate application of knowledge in a timely fashion. MATERIALS AND METHODS: Trauma providers were randomized to have or not have access to their smartphone during a timed, 10-question examination of trauma scenarios based on Eastern Association for the Surgery of Trauma, Western Trauma Association, and local protocols. Participants were then surveyed regarding their experience with the application. Groups were compared based on time with completion and percentage of correct answers. Subgroup analyses were completed to assess the utility of the application. RESULTS: Of 30 participants, 16 were randomized to smartphone use. Smartphone users took longer to complete the examination than nonusers (9:18 versus 6:36, P = 0.007) but answered a greater proportion of questions correctly (50% versus 40%, P = 0.159). Smartphone users had a higher percentage correct for Eastern Association for the Surgery of Trauma and Western Trauma Association protocol-based questions (78% versus 52%, P = 0.027; 70% versus 39%, P = 0.011), but no difference for local protocol-based questions (29% versus 37%, P = 0.48). Smartphone users who reported recent application use had the longest time to completion (11:44, P = 0.023) but the highest percentage correct (60%, P = 0.03). CONCLUSIONS: Smartphone use among those familiar with our trauma application resulted in the highest percentage correct but increased times to completion. The application interface should be streamlined, and providers educated to improve usage and reduce time to access information.


Assuntos
Sistemas de Apoio a Decisões Clínicas/instrumentação , Aplicativos Móveis , Sistemas Automatizados de Assistência Junto ao Leito , Ferimentos e Lesões/cirurgia , Adulto , Medicina Baseada em Evidências/instrumentação , Feminino , Humanos , Internet , Internato e Residência/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Smartphone , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
11.
BMC Health Serv Res ; 19(1): 219, 2019 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-30954074

RESUMO

BACKGROUND: Primary care workload is high and increasing in the United Kingdom. We sought to examine the association between rates of primary care consultation and outcomes in England. METHODS: Cross sectional observational study of routine electronic health care records in 283 practices from the Clinical Practice Research Datalink from April 2013 to March 2014. Outcomes included mortality rate, hospital admission rate, Quality and Outcomes Framework (QOF) performance and patient satisfaction. Relationships between consultation rates (with a general practitioner (GP) or nurse) and outcomes were investigated using negative binomial and ordinal logistic regression models. RESULTS: Rates of GP and nurse consultation (per patient person-year) were not associated with mortality or hospital admission rates: mortality incidence rate ratio (IRR) per unit change in GP/ nurse consultation rate = 1.01, 95% CI [0.98 to 1.04]/ 0.97, 95% CI [0.93 to 1.02]; hospital admission IRR per unit change in GP/ nurse consultation rate = 1.02, 95% CI [0.99 to 1.04]/ 0.98, 95% CI [0.94 to 1.032]. Higher rates of nurse but not GP consultation were associated with higher QOF achievement: OR = 1.91, 95% CI [1.39 to 2.62] per unit change in nurse consultation rate vs. OR = 1.04, 95% CI [0.87 to 1.24] per unit change in GP consultation rate. The association between the rates of GP/ nurse consultations and patient satisfaction was mixed. CONCLUSION: There are few associations between primary care consultation rates and outcomes. Previously identified demographic and staffing factors, rather than practice workload, appear to have the strongest relationships with mortality, admissions, performance and satisfaction. Studies with more detailed patient-level data would be required to explore these findings further.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Inglaterra/epidemiologia , Utilização de Instalações e Serviços , Feminino , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mortalidade , Profissionais de Enfermagem/estatística & dados numéricos , Satisfação do Paciente , Carga de Trabalho/estatística & dados numéricos
12.
J Clin Nurs ; 28(15-16): 2934-2945, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31013392

RESUMO

AIMS AND OBJECTIVES: To validate Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ) items using item response theory (IRT) models and conduct differential item functioning (DIF) analysis to test the item functioning among nurse practitioners (NPs) practicing in different U.S. states with variable regulations governing NP practice. BACKGROUND: Nurse Practitioner Primary Care Organizational Climate Questionnaire is the only NP-specific tool measuring NP work environment and is being used in different U.S. states with variable NP scope of practice regulations and internationally to produce evidence about NP work environments within their organisations. DESIGN: Cross-sectional survey design was used to collect data from 278 primary care NPs in New York (NY) and 314 NPs in Massachusetts (MA). METHODS: NPs completed the 29-item NP-PCOCQ. Data collection involved an online survey in NY and a mail survey in MA in 2012. We used Samejima's graded response model for IRT and ordinal logistic regression for DIF analysis. A STROBE checklist was completed. RESULTS: IRT models yielded discrimination parameters ranging from 0.98-4.65 in NY and 1.25-6.94 in MA. Item difficulty parameters were within -3 to +3 range, suggesting a fair range of item difficulties exist in the scale. Only five of the 29 items on NP-PCOCQ exhibited DIF, suggesting some other state-related factor besides the measured construct influenced item responses; thus, the items were removed. CONCLUSION: Our findings indicate that a shortened, 24-item NP-PCOCQ is capable of measuring organisational climate of NPs practicing in different U.S. states. NP-PCOCQ can be used in future research to measure NP work environment. RELEVANCE TO CLINICAL PRACTICE: The tool can also be used by practice administrators to assess NP work environment and identify deficiencies to address them. This evidence about NP work environment can be used by practice administrators to promote favourable work environments for NPs to deliver high-quality care.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Local de Trabalho/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , New York , Profissionais de Enfermagem/organização & administração , Relações Médico-Enfermeiro , Pesquisa Qualitativa , Inquéritos e Questionários
13.
Fam Med ; 51(4): 311-318, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30973618

RESUMO

BACKGROUND AND OBJECTIVES: Little is known about how the presence of nurse practitioners (NPs) and physician assistants (PAs) in a practice impacts family physicians' (FPs') scope of practice. This study sought to examine variations in FPs' practice associated with NPs and PAs. METHODS: We obtained data from American Board of Family Medicine practice demographic questionnaires completed by FPs who registered for the Family Medicine Certification Examination during 2013-2016. Scope of practice score was calculated for each FP, ranging from 0-30 with higher numbers equating to broader scope of practice. FPs self-reported patient panel size. Primary care teams were classified into NP only, PA only, both NP and PA, or no NP or PA. We estimated variation in scope and panel size with different team configurations in regression models. RESULTS: Of 27,836 FPs, nearly 70% had NPs or PAs in their practice but less than half (42.5%) estimated a panel size. Accounting for physician and practice characteristics, the presence of NPs and/or PAs was associated with significant increases in panel sizes (by 410 with PA only, 259 with NP only and 245 with both; all P<0.05) and in scope score (by 0.53 with PA only, 0.10 with NP only and 0.51 with both; all P<0.05). CONCLUSIONS: We found evidence that team-based care involving NPs and PAs was associated with higher practice capacity of FPs. Working with PAs seemed to allow FPs to see a greater number of patients and provide more services than working with NPs. Delineation of primary care team roles, responsibilities and boundaries may explain these findings.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Inquéritos e Questionários , Estados Unidos
14.
Am J Emerg Med ; 37(5): 928-932, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30733103

RESUMO

OBJECTIVE: As nurse practitioners (NPs) and physician assistants (PAs) become an integral part of delivering emergency medical services, we examined the involvement of NPs and PAs who billed independently in emergency departments (EDs). METHODS: We used Medicare provider utilization and payment data from 2012 to 2016 to conduct a retrospective analysis. We examined the changes in the number of each clinician type who billed independently for four common emergency services (CPT codes: 99282-5), the change in their service volume, and the change in their average number of services billed. RESULTS: Between 2012 and 2016, the proportion of NPs and PAs billing independently increased from 18% to 22% for ED visits of low severity (99282), 23% to 29% for visits with moderate severity (99283), 21% to 27% for visits with high severity (99284), 18% to 24% for visit with the highest severity (99285), and 23% to 29% across all four services. The proportion of services provided by emergency physicians decreased from 66% to 63% across all four services, and from 11% to 9% for internists and family physicians. The number of NPs, PAs billing independently, and emergency physicians increased by 65%, 35% and 12% respectively. CONCLUSIONS: NPs and PAs are increasingly billing emergency services of all levels of severity, independent of physicians. This trend is driven by a growing number of NPs and PAs independently billing services, despite a relatively stable number of emergency physicians (excepting the decline in rural areas), and diminished involvement of family physicians and internists in EDs.


Assuntos
Serviço Hospitalar de Emergência , Honorários e Preços/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Medicina de Emergência , Mão de Obra em Saúde , Humanos , Medicare , Médicos , Índice de Gravidade de Doença , Estados Unidos
15.
J Am Assoc Nurse Pract ; 31(4): 236-244, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30681653

RESUMO

BACKGROUND AND OBJECTIVES: Obesity prevalence rates for adults are at an all-time high. This systematic review of the literature aimed to examine the practice patterns of nurse practitioners (NPs) related to weight management in primary care and recommend future areas of research as it relates to the diagnosis and management of patients with obesity by NPs. DATA SOURCES: The databases CINAHL PLUS with Full Text, Cochrane Central Register of Controlled Trials, ERIC, MEDLINE, PsycINFO, and SPORTDiscuss were searched. CONCLUSIONS: The initial search resulted in 169 articles. Fifteen peer-reviewed articles from 13 studies were included in the analysis. Four themes emerged from the analysis: approach to practice; the practitioner's role within the interdisciplinary team; communication; and resources and tools. IMPLICATIONS FOR PRACTICE: This review was conducted to better understand the challenges and facilitators to the management of patients with obesity in primary care. Future research between NPs and variables related to obesity are necessary to further identify areas for education, training, and policy development.


Assuntos
Manutenção do Peso Corporal , Profissionais de Enfermagem/estatística & dados numéricos , Padrões de Prática em Enfermagem/tendências , Atenção Primária à Saúde/métodos , Promoção da Saúde/métodos , Humanos , Profissionais de Enfermagem/normas , Relações Enfermeiro-Paciente , Obesidade/terapia
16.
J Telemed Telecare ; 25(4): 213-220, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29498301

RESUMO

INTRODUCTION: Since 2010, more than 75 rural hospitals have closed in the USA and more than one-third are at risk of closure due to lower patient volumes, lower funding levels, decreased hospital revenue and lower physician employment pools. Telemedicine can provide new models of care delivery that maintain quality and reduce cost of healthcare in rural populations. The purpose of this project was to evaluate a cross-organizational pilot program by comparing a NP/telemedicine physician hospitalist programme with a traditional physician hospitalist model to assess effects on length of patient stay, mortality rates, readmission rate, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings of provider communication, and total hospital costs. METHODS: The Standard for Quality Improvement Reporting Excellence (SQUIRE) guidelines were followed. Using a one-year retrospective chart review, average length of stay, mortality rates, 30-day readmission rates and provider communication ratings were compared between hospitalists that were nurse practitioners working with physicians through telemedicine support and physicians alone. RESULTS: There was no statistically significant variance in average length of stay, mortality rates, 30-day readmission rates, or provider communication ratings on HCAHPS surveys compared to the NP or physician hospitalist. DISCUSSION: This new model of care demonstrates that telemedicine can be used to provide safe and efficient physician support from a regional hub medical centre to nurse practitioners practising as hospitalists in rural Critical Access Hospitals at up to 58% cost savings while maintaining quality of care and increasing access to community-based physicians.


Assuntos
Médicos Hospitalares/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Serviços Urbanos de Saúde/organização & administração , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos
17.
Compr Child Adolesc Nurs ; 42(2): 124-140, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29521544

RESUMO

The significant trend of the obesity epidemic leading to treatment of expensive, lifelong illnesses, especially among Hispanic children, confirms the need for efforts to increase provider adherence to clinical guidelines. This Quality Improvement Project was designed to examine how a practice intervention influenced provider adherence to childhood obesity guidelines among Hispanic children. The practice intervention, based on a unique practice model, consisted of provider awareness, provider involvement, and collaborative support by the researcher. Statistically significant results were obtained regarding guideline adherence. The practice model developed for implementing guidelines in this study will be of benefit to other clinicians. The main project outcome was that the model resulted in significant changes in practice patterns and increased provider adherence to aspects of childhood obesity clinical guidelines. The Practice Improvement Model should be replicated in other settings to evaluate its contribution to improved adherence to any clinical practice guideline.


Assuntos
Fidelidade a Diretrizes/normas , Profissionais de Enfermagem/normas , Obesidade Pediátrica/terapia , Cooperação e Adesão ao Tratamento/psicologia , Índice de Massa Corporal , Criança , Feminino , Hispano-Americanos , Humanos , Masculino , Profissionais de Enfermagem/psicologia , Profissionais de Enfermagem/estatística & dados numéricos , Obesidade Pediátrica/psicologia , Melhoria de Qualidade/tendências , Estudos Retrospectivos
18.
Aust Health Rev ; 43(1): 55-61, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29031290

RESUMO

Objective Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. Methods PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Results Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n=25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n=55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n=64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included 'duplication of services' and 'level of reimbursement'. Conclusion The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. What is known about the topic? Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. What does this paper add? This paper provides data on PPNPs' provision of care subsidised through the MBS and PBS. What are the implications for practitioners? Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care.


Assuntos
Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Prática Privada de Enfermagem/estatística & dados numéricos , Adulto , Idoso , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/economia , Prática Privada de Enfermagem/economia , Preparações Farmacêuticas , Inquéritos e Questionários
19.
J Am Assoc Nurse Pract ; 31(3): 198-205, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30550389

RESUMO

BACKGROUND AND PURPOSE: To date, there has been no policy analysis or review of the effectiveness of the current nurse practitioner (NP) scope of practice regulations in Taiwan. The purpose is of this article was to provide a policy analysis of NP scope of practice regulations in Taiwan. METHODS: The Longest policy cycle model was used to analyze the NP scope of practice regulations. Policy formation, policy implementation, and policy modification are three steps in this model. Policy formation and policy implementation are described in the first two sections. Regarding policy modification, we used the data collected from a research grant to evaluate the implementation of the NP scope of practice regulations to present the effectiveness of the policy endorsement in Taiwan. CONCLUSIONS: The impact of health care services provided by NPs was positive from the viewpoint of the hospital. The top-ranking impact was reducing physicians' workload and increasing the effectiveness of communication and coordination among the team. IMPLICATIONS FOR PRACTICE: The economic value of advanced practice nurses needs to be identified, as it can result in optimal professional growth. The Taiwan Association of Nurse Practitioners can design the metrics to measure NPs' contribution and to analyze the financial benefits bestowed by the NP profession based on the study results.


Assuntos
Política de Saúde , Profissionais de Enfermagem/legislação & jurisprudência , Papel do Profissional de Enfermagem , Atenção Primária à Saúde/métodos , Humanos , Profissionais de Enfermagem/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Taiwan
20.
Am J Emerg Med ; 37(8): 1439-1445, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30377010

RESUMO

PURPOSE: To describe opioid prescribing practice patterns and trends in emergency department visits (EDs) by provider type: physicians and advanced practice providers (APPs), which include nurse practitioners (NPs) and physician assistants (PAs). METHODS: The data source was the ED visit files of the 2005-2015 National Hospital Ambulatory Care Survey. The study sample was opioid prescription-related ED visits. Descriptive and multinomial logistic regression analyses were conducted to assess the proportion of opioid prescription-related visits by provider type over time in total and by patient age group. We then characterized opioid prescribing practices of NPs, PAs, and physicians according to type of opioid and pain-related diagnosis. RESULTS: From 2005 to 2015, there was a 116.7% increase in the proportion of the opioid prescription-related visits seen by NPs and a 61.2% increase seen by both APPs and physicians. In contrast, the proportion of the physician-only visits decreased (-8.3%). When stratified by age group, the growth was particularly notable among the visits with patients aged 65 and older seen by both APPs and physicians (AOR = 2.35, 95% CI = 1.69, 3.25). Proportionally less hydromorphone and morphine was prescribed by APPs than by physicians. Opioids were prescribed more often by APPs in visits involving dental and injury-related pain, whereas physicians prescribed opioids more in abdominal and chest pain-related visits. CONCLUSIONS: From 2005 to 2015, APPs, particularly NPs played an increasing role in opioid prescribing in EDs. Opioid prescribing practices of APPs and physicians varied by patient condition as well as by opioid type.


Assuntos
Analgésicos Opioides/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Dor/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Hidromorfona/uso terapêutico , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Estados Unidos , Adulto Jovem
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