Abstract
Background: For decades, U.S. rural areas have experienced shortages of primary care providers. Nurse practitioners (NPs) are helping to reduce that shortage. However, NP scope of practice regulations vary from state-to-state ranging from autonomous practice to direct physician oversight. The purpose of this study was to determine if clinical outcomes of older rural adult patients vary by the level of practice autonomy that states grant to NPs. Methods: This cross-sectional study analyzed data from a sample of Rural Health Clinics (RHCs) (n = 503) located in eight Southeastern states. Independent t-tests were performed for each of five variables to compare patient outcomes of the experimental RHCs (those in “reduced practice” states) to those of the control RHCs (in “restricted practice” states). Results: After matching, no statistically significant difference was found in patient outcomes for RHCs in reduced practice states compared to those in restricted practice states. Yet, expanded scope of practice may improve provider supply, healthcare access and utilization, and quality of care (Martsolf et al., 2016). Conclusions: Although this study found no significant relationship between Advanced Registered Nurse Practitioner (ARNP) scope of practice and select patient outcome variables, there are strong indications that the quality of patient outcomes is not reduced when the scope of practice is expanded.
Highlights
Rural areas across the U.S have experienced persistent shortages of primary care providers, leaving rural residents at greater risk for health problems and illness complications.Rural communities differ from each other; both rural and urban areas are becoming more culturally diverse
The principal aim of the study was to determine how clinical outcomes of older adult patients vary by level of practice autonomy that states grant to Advanced Registered Nurse Practitioner (ARNP)
Most (34.4%) of the Rural Health Clinics (RHCs) in restricted practice states belonged to Rural-Urban Commuting Area (RUCA) category “urban,” whereas more than half of the RHCs in reduced practice states were classified into RUCA categories “large” and “small” rural
Summary
Rural areas across the U.S have experienced persistent shortages of primary care providers, leaving rural residents at greater risk for health problems and illness complications.Rural communities differ from each other; both rural and urban areas are becoming more culturally diverse. Hispanics/Latinos, African Americans, and other subgroups differ from the majority population regarding their beliefs and preferences about health, illness, and their ability to access health care. These distinctions, in the absence of culturally sensitive healthcare, may contribute to health disparities of the subgroup as compared to the majority population. The purpose of this study was to determine if clinical outcomes of older rural adult patients vary by the level of practice autonomy that states grant to NPs. Methods: This cross-sectional study analyzed data from a sample of Rural Health Clinics (RHCs) (n = 503) located in eight. Independent t-tests were performed for each of five variables to compare patient outcomes of the experimental RHCs (those in “reduced practice” states) to those of the control
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