Category Archives: Physician assistants
CDC Study: Nurses, Physician Assistants More Likely to Provide Education in Chronic Disease Management than Doctors
Proper patient management of chronic diseases is increasingly important to the nation’s health care system, as the Baby Boom generation reaches the stage of life where such conditions are common. From diabetes, arthritis, and asthma to obesity, hypertension, and depression, the health care system is looking to train patients to take steps mapped out for them in discussions with their health care providers. A new study from the Centers for Disease Control and Prevention (CDC), however, finds that a minority of patients with chronic conditions receive education in managing their problems, and that some practitioners—nurses and physician assistants (PAs), in particular—are considerably more likely to provide such education than others.
“Disease self-management is an essential component of care for patients with most chronic conditions,” writes a team of researchers led by Tamara S. Ritsema, MPH, MMSc, PA-C. “Patients cannot perform daily self-management tasks if they have poor understanding of the disease process, medications used, or the practical tasks they need to accomplish to care for themselves. Health education is, therefore, a vital preventive element in the patient visit.”
The researchers examined five years of CDC data, accounting for more than 136,000 patients who had been diagnosed with asthma, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, ischemic heart disease, or obesity. The records indicated whether the patients’ doctors, nurse practitioners (NPs), or PAs had provided education to the patients in the self-management of their conditions during each visit.
One of the key recommendations in the landmark Institute of Medicine report on the future of nursing is to advance access to primary care by reducing barriers to practice for nurses. Implementation of this recommendation is now one step closer, thanks to a provision in President Obama’s budget proposal for fiscal year 2015, which was released this month.
Obama’s budget includes a provision that would extend an increase in Medicaid payments for primary care providers for one year at a cost of about $5.4 billion, according to an article in USA Today. The extension would, for the first time, apply to nurse practitioners (NPs) and physician assistants (PAs).
The Institute of Medicine recommended fixing this Medicaid “glitch” in its report on the future of nursing. The report is the foundation for the Future of Nursing: Campaign for Action, a national effort backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is working to transform health care through nursing.
Obama’s budget proposal also calls for nearly $4 billion over six years to grow the National Health Services Corps (NHSC) from 8,900 primary care providers to at least 15,000 providers annually, starting in 2015, according to an analysis by the Campaign. Ten percent of the funding would be reserved for NPs and PAs.
Linda H. Aiken, PhD, FAAN, FRCN, RN, is the Claire M. Fagin Leadership Professor in Nursing, a professor of sociology, and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Aiken is a research manager supporting the Future of Nursing: Campaign for Action and a National Advisory Committee member for the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. This is cross-posted on the Leonard Davis Institute Voices blog.
All too often, the debate about expanding the role of nurse practitioners (NPs) and physician’s assistants (PAs) takes place in a vacuum, as though these practitioners do not already deliver significant amounts of primary care. But they do, and existing evidence indicates that quality of care and patient satisfaction are good as a result.
Even before the passage of the Affordable Care Act, the nation had a shortage of primary care providers. The shortage is likely to intensify when the demand for primary care increases as millions become insured. The numbers of and roles assumed by NPs and PAs have been growing steadily, and allowing these providers to take on an even greater role could address the increased demand for primary care.