scholarly journals Prescribing Practices by Nurse Practitioners and Primary Care Physicians: A Descriptive Analysis of Medicare Beneficiaries

2017 ◽  
Vol 8 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Ulrike Muench ◽  
Jennifer Perloff ◽  
Cindy Parks Thomas ◽  
Peter I. Buerhaus
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Descriptive Analysis ◽  
Medicare Beneficiaries ◽  
Prescribing Practices

scholarly journals Advanced Practice Clinicians Providing an Increased Share of Primary Care in Skilled Nursing Facilities, 2008-2016

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 87-87
Author(s):  
Elizabeth White ◽  
Cyrus Kosar ◽  
Momotazur Rahman
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Medicare Beneficiaries ◽  
Medical Providers ◽  
Skilled Nursing ◽  
For Profit

Abstract Rising care complexity in skilled nursing facilities (SNFs), coupled with growing shortages of geriatricians and other primary care physicians able to see SNF patients, have increased demand for nurse practitioners and physician assistants (NP/PAs). We used 2008-2016 Medicare Part A and B claims and nursing home assessment data to describe longitudinal trends in NP/PA practice in SNFs. We identified 8,877,094 SNF post-acute primary care visits for 1,494,113 Medicare beneficiaries. The total number of visits increased from 850,285 in 2008 to 1,189,553 in 2016. The share of visits by NP/PAs rose significantly over time, from 24% of visits in 2008 to 43% in 2016. 71% of SNFs (n=10,139) used NP/PAs in 2016, up from 46% (n=6,696) in 2008. The number of NP/PAs practicing in SNFs more than doubled, from 4,472 clinicians in 2008 to 10,000 in 2016. The number of physicians practicing in SNFs declined from 26,297 in 2008 to 19,745 in 2016. NP/PAs represented 14% of all SNF medical providers in 2008 and 34% of providers in 2016. In 2016, 48% of NP/PAs were SNFists (i.e. >90% of visits billed in SNF), vs. only 11% of physicians. SNFs with NP/PAs are on average larger, more likely urban, for profit, and care for larger populations of racial minorities, than SNFs without NP/PAs. SNFs with NP/PAs also have more short-stay Medicare residents, more admissions, higher nurse and rehab staffing levels, and higher case mix. These findings show that NP/PAs are taking on increasingly prominent roles as medical providers in SNFs.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

scholarly journals Factors influencing general practitioners’ perception of and attitude towards dementia diagnostics and care—results of a survey among primary care physicians in Germany

2021 ◽  
Author(s):  
Julian Wangler ◽  
Michael Jansky
Keyword(s):  
Primary Care ◽  
Influencing Factors ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Descriptive Analysis ◽  
Linear Regression Analysis ◽  
Interdisciplinary Cooperation ◽  
Practice Staff ◽  
People With Dementia ◽  
Dementia Diagnostics

SummaryStudies have shown that primary care is not always effective when it comes to caring for people with dementia. In addition, general practitioners do not always use diagnostic instruments consistently. The aim of the study was to identify relevant factors that influence general practitioners’ attitudes and willingness with respect to consistent diagnosis and care. For this purpose, resources, viewpoints, and behavioral patterns of general practitioners with regard to dementia diagnostics as well as common challenges in everyday practice were recorded. In the course of a survey, a total of 2266 general practitioners in Hesse and Baden-Württemberg were interviewed between January and March 2020. In addition to the descriptive analysis, a t-test was used to determine significant differences between two groups. A univariate linear regression analysis was carried out to identify possible influencing factors. 81% of the respondents do provide dementia diagnostics; 51% are involved in the treatment. Most of them see the diagnostic work-up (77%), communication and compliance problems (73%), as well as the therapeutic support (71%) as common challenges. In addition, there are interface problems regarding the interdisciplinary cooperation. Some of the respondents express doubts about the value of early detection (41%). The general practitioners’ attitude with respect to dementia diagnostics and care is determined by influencing factors that relate to geriatric competencies, expectations of self-efficacy, the integration of practice staff, as well as the knowledge of and cooperation with counseling and care services. It seems advisable to strengthen the geriatric competence of general practitioners. Moreover, it appears essential to educate general practitioners more about support structures in the field of dementia care and to integrate them accordingly. In addition, practice staff should be more systematically involved in the identification and care of dementia patients.

Coordinated Primary Care (“Medical Home” Model)

2009 ◽  
Vol 2 (2) ◽  
pp. 60-64 ◽  
Author(s):  
Mary Petermann Garnica
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Medical Home ◽  
Primary Care Physicians ◽  
Team Leaders ◽  
Care Nurse ◽  
Medical Home Model ◽  
Primary Care Practices ◽  
Primary Care Medical Home

Health care is inaccessible and too expensive for a large segment of the U.S. population. In addition, the past decade has produced many reports of significant problems related to safety, quality, and effectiveness in U.S. health care. The future of primary care is in question because of a current and projected worsening shortage of primary care physicians. A physician-led coordinated primary care model has been endorsed by major physicians groups as having the potential to address many of these problems. The model, also known as the “medical home,” has gained momentum and appears likely to play a central role as the nation moves forward to reform health care. Nurse practitioners have traditionally practiced “coordinated primary care” and are ideally suited to lead practices adopting this model of care. This article provides rationale for nurse practitioners to be fully recognized as team leaders of coordinated primary care practices.

Diabetes Care for Medicare Beneficiaries: Attitudes and behaviors of primary care physicians

Diabetes Care ◽  
1998 ◽  
Vol 21 (8) ◽  
pp. 1282-1287 ◽  
Author(s):  
J. Drass ◽  
S. Kell ◽  
M. Osborn ◽  
B. Bausell ◽  
J. Corcoran ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetes Care ◽  
Primary Care Physicians ◽  
Medicare Beneficiaries ◽  
Attitudes And Behaviors ◽  
And Behaviors

Association of State-Level Restrictions in Nurse Practitioner Scope of Practice With the Quality of Primary Care Provided to Medicare Beneficiaries

2017 ◽  
Vol 76 (5) ◽  
pp. 597-626 ◽  
Author(s):  
Jennifer Perloff ◽  
Sean Clarke ◽  
Catherine M. DesRoches ◽  
Monica O’Reilly-Jacob ◽  
Peter Buerhaus
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Primary Care Physicians ◽  
Scope Of Practice ◽  
Care Nurse ◽  
State Regulations ◽  
Primary Care Nurse ◽  
Quality Of Primary Care

Context: State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. Method: This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care. Findings: Results show a lack of consistent association between quality of primary care provided by NPs and state SoP restrictions. Conclusion: State regulations restricting NP SoP do not improve the quality of care.

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