Impact of Beliefs about Local Physician Supply and Self-rated Health on Willingness to See a Nurse Practitioner during the COVID-19 Pandemic: Online Survey and Experiment.

Abstract

The coronavirus (COVID-19) pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see a NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting they may be willing to see a NP. Evaluate the public's willingness to see a NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Conduct two studies: 1) a survey to identify correlations; and 2) an experiment to assess how willingness is dependent on information about the local supply of physicians. The survey and experiment were conducted online in April and December 2020, respectively. Participants were U.S. adults recruited from Amazon's Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized five-point scale (Excellent, Very Good, Good vs. Fair, Poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs via altering information the participants read about the local supply of physicians. Willingness to see a NP was assessed as an overall preference over a physician and as a preference given two clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and analysis of variance were used to assess how beliefs as about the local physician supply and self-rated health were associated with overall willingness to see a NP. Bivariate probits simultaneously estimated willingness to see a NP in the two clinically significant scenarios. The survey showed concerns about physician supply was associated with lower willingness to see a NP among respondents with comparatively better health, but a greater willingness among respondents with comparatively worse health. The experiment suggests only the latter is causal. For the two clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment. U.S. adults with comparatively worse self-rated health become more willing to see a NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed.