Primary Care Nurse Practitioners Research Articles

Nursing Within Primary Care Settings in Atlantic Canada: A Scoping Review

To address the prevalence of chronic diseases in Newfoundland and Labrador, the province has committed to primary health care reform, including implementing interdisciplinary primary care (PC) teams. To inform discussions regarding integrating nurse practitioners (NPs), registered nurses (RNs), and licensed practical nurses (LPNs) into these teams, better understanding of their roles in PC is needed. A scoping review was conducted to examine and synthesize existing evidence related to nursing roles and resources in PC settings across Atlantic Canada (Newfoundland and Labrador, New Brunswick, Nova Scotia, Prince Edward Island), and associated contributions to patient care. Joanna Briggs Institute scoping review methodology was used. The Nursing Role Effectiveness Model guided the review. Twenty articles met inclusion criteria. Roles of RNs and NPs in PC included chronic disease management, education, and health promotion. No literature focused on LPNs. Interdisciplinary collaboration was evident across studies. However, nurses’ functions within teams were limited by institutional constraints and other providers. PC settings with nurses had positive clinical outcomes, improved access to services, and high patient satisfaction. The prevalence of nursing in PC throughout Atlantic Canada and how nurses’ roles are enacted is unclear. There is opportunity for future inquiry into specific attributes of nursing and PC teams that result in positive patient and system outcomes.

Managing Cancer Survivorship Issues

According to the National Cancer Institute, there were more than 15.5 million cancer survivors in the United States as of 2016, and this number is expected to grow. Cancer survivors have to endure the disease and treatment effects, financial burden, employment and health insurance, and relationship issues. These issues can affect survivors’ quality of life. Primary care nurse practitioners (PCNPs) are in the frontline of improving survivors' quality of life by managing and minimizing the impact of these issues. This article will cover these issues and the role of PCNPs.

Can Primary Care Nurse Practitioners Provide Survivorship Care to Cancer Patients?

Can Primary Care Nurse Practitioners Provide Survivorship Care to Cancer Patients?

A National Study of Australian Nurse Practitioners’ Organizational Practice Environment

The nurse practitioner (NP) workforce in Australia plays a vital role in helping the country meet the current demand for health care. Data from Australian NPs using the Nurse Practitioner Primary Care Organizational Climate Questionnaire demonstrated that one-seventh of the overall Australian NP population completed the study. The response was overwhelmingly positive in the area of practice; 71.6% of NPs had no restriction on their practice and felt valued by their organization. The results of this study enable a benchmark for ongoing national evaluations in addition to international comparative data.

Colorectal Cancer – An Update for Primary Care Nurse Practitioners

Abstract The picture of colorectal cancer (CRC) is changing. Our understanding of factors that drive the growth of CRC, the image of a CRC patient, and our approach to treating CRC is all evolving. This article will bring the picture into clearer focus. We will start with an update of the pathogenesis of CRC, review screening methods, look at a meta-analysis of risk factors, then follow with new information about the concern of younger patients developing CRC. We finish with a look at a new treatment option. With this more focused view, nurse practitioners can screen more effectively for colorectal cancer.

Preventing New Human Immunodeficiency Virus Infections With Pre-exposure Prophylaxis

Abstract Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir (TDF/FTC) can reduce HIV infection risk by 92% in people at high risk for HIV. TDF/FTC was approved for HIV PrEP by the Food and Drug Administration in 2012. Primary care nurse practitioners (NPs) have not embraced this tool for the prevention of new HIV infection. A number of barriers exist that may prevent primary care NPs from prescribing HIV PrEP for patients in need. This article clarifies current recommendations for HIV PrEP and provides practical guidance for primary care NPs to incorporate this tool into their routine practice.

Primary Care Nurse Practitioner Wage Differences by Employment Setting

Primary Care Nurse Practitioner Wage Differences by Employment Setting

Thinking about health care differently: nurse practitioners in primary health care as social entrepreneurs.

INTRODUCTION Challenges facing the primary health-care sector mean that policymakers and clinicians need to think and act differently to move forward. The principles of social entrepreneurship have been implemented successfully for improved health outcomes in other developed nations. There is a knowledge gap around whether nurse practitioners (NPs) in New Zealand primary health care (PHC) align with these principles. AIM To explore whether and how the innovative activities of primary care NPs can be described as socially entrepreneurial. METHODS A descriptive qualitative approach was used with data collected using semi-structured interviews with NPs working in primary care (n = 7). Data were analysed using general inductive thematic analysis techniques. RESULTS Nurse practitioners interviewed worked in government-subsidised private general practice businesses. Two main themes emerged: (1) the nursing model of care aligned with social entrepreneurship; and (2) building social capital. NPs described a desire to see health care delivered differently and this aligned with acting as a social entrepreneur. Social capital emerged through the requirement to establish significant collaborative relationships. DISCUSSION It was found that NPs' work can be described as socially entrepreneurial. The holistic, person and community-centred model of NP care has an ultimate mission of improved health outcomes. Social capital is built through collaborative relationships with other health-care providers, individual service users and the community. However, the juxtaposition of the business model in primary care prevents NPs from initiating and leading sustainable change.

Advance Care Planning in Early Stage Dementia

Abstract Dementia is a chronic illness that involves progressive loss of cognitive and functional abilities. In the early stages, persons with dementia actively face their cognitive decline, adjust to cognitive loss, and are able to take an active role in discussing values and preferences for future care. Preparing patients and families for what to expect in the course of dementia is vital in ascertaining an individual's wishes regarding supportive and life-sustaining interventions. Nurse practitioners in primary care have a responsibility to initiate advance care planning conversations with persons in the early stages of dementia.

The quality of primary care provided by nurse practitioners to vulnerable Medicare beneficiaries

BackgroundStudies suggest nurse practitioners are heavily represented among primary care providers for vulnerable Medicare beneficiaries. PurposeThe purpose of this study was to compare quality indicators among three groups of vulnerable beneficiaries managed by MDs and nurse practitioners (NPs). MethodsThe methods include retrospective cohort design examining 2012 and 2013 Medicare claims for three beneficiary groups: (a) initially qualified for the program due to disability, (b) dually eligible for Medicare and Medicaid, and (c) both disabled and dually eligible. Validated quality indicators in four domains were analyzed. DiscussionGaps in outcomes suggest better performance for primary care nurse practitioners (PCNPs) in preventable hospitalizations and adverse outcomes. Outcome gaps suggesting better performance for primary care physicians in chronic disease management were diminished for beneficiaries who were both disabled and dually eligible suggesting improved performance for PCNPs within this subpopulation. ConclusionThese findings add new evidence indicating the quality of primary care provided to vulnerable Medicare beneficiaries by PCNPs is generally consistent with clinical guidelines and the less intensive use of costly health care services.

Development and evaluation of a culturally appropriate hypertension education (CAHE) training program for health care providers.

BackgroundIn Western countries, hypertension and hypertension-related complication are more common in ethnic minority groups of African descent than in indigenous populations. Addressing ethnic minority patients’ perceptions of hypertension and its treatment through the use of cultural appropriate hypertension education (CAHE) increases adherence to medication and lifestyle recommendations. Given these effects, it seems warranted to develop a training program on how to deliver this type of patient education for Primary Care Nurse Practitioners (PCNPs).ObjectiveDevelopment and evaluation of a training program for PCNPs aimed at providing culturally appropriate hypertension patient education.DesignProspective cohort study evaluating attitude and intended behavioral changes.ParticipantsBoth experienced PCNPs and PCNPs in training participated in this study.Main measuresThe effects of the CAHE-training were measured by 3 different questionnaires on 1) the satisfaction with the training program, 2) the attitude towards culturally appropriate care, and 3) the commitment to change.ResultsThe CAHE-training program consists of 10 different components divided over two 4-hour sessions and was taught to 87 participating PCNPs. The program utilizes constructivist-learning principles and educational evidence on adult learning. The content of the program is based on the knowledge obtained from our previous studies on culturally appropriate care. The mean satisfaction-score was 7.5 (1–10 scale), with the role-play exercise with patient-actors scoring highest (8.2). We observed non-significant but positive changes in attitude. PCNPs who reported on the implementation of their intended behavior change showed significant attitude changes after three months.ConclusionWe demonstrated that our evidence based training program for PCNPs resulted in a positive learning experience with adequate intended behavioral changes in practice. Unfortunately, response rates were too low to demonstrate persistent changes in attitude.

Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.

Few studies have examined differences in functional, cognitive, and psychological factors between patients utilizing only nurse practitioners (NPs) and those utilizing only primary care medical doctors (PCMDs) for primary care. Patients utilizing NP-only or PCMD-only models for primary care will be characterized and compared in terms of functional, cognitive, and psychological factors. Cohorts were obtained from the Medicare Current Beneficiary Survey linked to Medicare claims data. Weighted analysis was conducted to compare the patients within the two care models in terms of functional, cognitive, and psychological factors. From 2007 to 2013, there was a 170% increase in patients utilizing only NPs for primary care. In terms of health status, patients utilizing only NPs in their primary care were not statistically different from patients utilizing only PCMDs. There is a perception that NPs, as compared with PCMDs, tend to provide care to healthier patients. Our results are contrary to this perception. In terms of health status, NP-only patients are similar to PCMD-only patients. Results of this study may inform research comparing NP-only care and PCMD-only care using Medicare and the utilization of NPs in primary care.

Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study

BackgroundHealth care systems globally are facing challenges of meeting the growing demand for primary care services due to a shortage of primary care physicians. Policy makers and administrators are searching for solutions to increase the primary care capacity. The effective utilization of nurse practitioners (NPs) has been proposed as a solution. However, organizations utilize NPs in variable capacities. In some settings, NPs serve as primary care providers delivering ongoing continuous care to their patients, referred to as patient panels, whereas in other settings they deliver episodic care. Little is known about why organizations deploy NPs differently. ObjectivesInvestigate the NP role in care delivery—primary care providers with the own patient panels or delivering episodic care—within their organizations and understand how work environments affect their role. DesignA cross-sectional survey design was used to collect data from primary care NPs. SettingsThe study was conducted in one state in the United States (Massachusetts). Data from 163 primary care organizations was obtained, which employed between one to 12 NPs. Participants807 NPs recruited from the Massachusetts Provider Database received mail surveys; 314 completed and returned the survey, yielding a response rate of 40%. MethodsThe survey contained measures of NP role in care delivery and work environment. NP role was measured by an item asking NPs to report if they deliver ongoing continuous care to their patient panel or if they do not have patient panel. The work environment was measured with the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ). The multilevel Cox regression models investigated the influence of organization-level work environment on NP role in care delivery. ResultsAbout 45% of NPs served as primary care providers with their own patient panel. Organization-level Independent Practice and Support subscale, an NP-PCOCQ subscale, had a significant positive effect on NP role (risk ratio=2.33; 95% CI: 1.06-5.13); with a one unit increase on this subscale, the incidence of the NPs serving as primary care providers with their own patient panel doubled. ConclusionsNPs can help meet the increasing demand for primary care by taking responsibilities as primary care providers, and organizations can assign NPs their own patient panels. Supporting NP independent practice within organizations promotes NP role as primary care providers. Policy and organizational change focused on promoting NP work environments so NPs can practice as primary care providers can be an effective strategy to increase the primary care capacity.

Should Primary Care Nurse Practitioners be Permitted to Work in Acute Care Settings?

Should Primary Care Nurse Practitioners be Permitted to Work in Acute Care Settings?

Primary Care Nurse Practitioners' Perceptions of the Use of E-Cigarettes

Research about e-cigarette use is emerging and there is no clear evidence about the effectiveness of their use in smoking cessation. The purpose of this study was to explore the knowledge and attitudes of primary care nurse practitioners (NPs) toward e-cigarettes. A nonexperimental, descriptive study was conducted with primary care NPs (N = 93). Thirty-five percent of NPs believed that e-cigarettes were healthier than traditional cigarettes; 60% endorsed using them for cessation and 19% thought they were as effective as nicotine replacement therapies. Given NPs’ varying opinions regarding the use of e-cigarettes, more education regarding evidence on e-cigarette health risks and limited cessation efficacy is necessary.

Multiple Myeloma: The Role of the Primary Care Nurse Practitioner

Multiple myeloma is a hematologic disease characterized by an excessive number of abnormal plasma cells that infiltrate the bone marrow and overproduction of monoclonal immunoglobulins. It is the third most prevalent hematologic disease and makes up just over 15% of all hematologic malignancies. Patients may present with 1 or more nonspecific symptoms of hypercalcemia, renal insufficiency, anemia, or new-onset bone pain. Early recognition, referral, and monitoring may improve the quality of life and extend the survival of patients.

Perspectives: Using Results from HRSA's Health Workforce Simulation Model to Examine the Geography of Primary Care.

Inform health planning and policy discussions by describing Health Resources and Services Administration's (HRSA's) Health Workforce Simulation Model (HWSM) and examining the HWSM's 2025 supply and demand projections for primary care physicians, nurse practitioners (NPs), and physician assistants (PAs). HRSA's recently published projections for primary care providers derive from an integrated microsimulation model that estimates health workforce supply and demand at national, regional, and state levels. Thirty-seven states are projected to have shortages of primary care physicians in 2025, and nine states are projected to have shortages of both primary care physicians and PAs. While no state is projected to have a 2025 shortage of primary care NPs, many states are expected to have only a small surplus. Primary care physician shortages are projected for all parts of the United States, while primary care PA shortages are generally confined to Midwestern and Southern states. No state is projected to have shortages of all three provider types. Projected shortages must be considered in the context of baseline assumptions regarding current supply, demand, provider-service ratios, and other factors. Still, these findings suggest geographies with possible primary care workforce shortages in 2025 and offer opportunities for targeting efforts to enhance workforce flexibility.

Promoting Physical Activity and Exercise in Patients With Asthma and Chronic Obstructive Pulmonary Disease

Chronic lower respiratory diseases, including asthma and chronic obstructive pulmonary disease, are a significant public health burden owing to their high incidence and prevalence. Nurse practitioners in primary care routinely see patients with these diagnoses. Although inhaled pharmacotherapy is the mainstay of treatment for individuals with these diseases, providing an overall approach to health and wellness, which includes physical activity and exercise, is imperative in optimizing patient outcomes. The purpose of this article is to provide nurse practitioners in primary care with foundational information regarding the promotion of physical activity and exercise for patients with asthma and chronic obstructive pulmonary disease.

Validation of Nurse Practitioner Primary Care Organizational Climate Questionnaire: A New Tool to Study Nurse Practitioner Practice Settings.

Favorable organizational climate in primary care settings is necessary to expand the nurse practitioner (NP) workforce and promote their practice. Only one NP-specific tool, the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), measures NP organizational climate. We confirmed NP-PCOCQ's factor structure and established its predictive validity. A crosssectional survey design was used to collect data from 314 NPs in Massachusetts in 2012. Confirmatory factor analysis and regression models were used. The 4-factor model characterized NP-PCOCQ. The NP-PCOCQ score predicted job satisfaction (beta = .36; p < .001) and intent to leave job (odds ratio = .28; p = .011). NP-PCOCQ can be used by researchers to produce new evidence and by administrators to assess organizational climate in their clinics. Further testing of NP-PCOCQ is needed.

Establishing a Viable Workforce Pipeline of Primary Care Nurse Practitioners: Benefits of a Health System and Academic Partnership.

Maldistribution and shortages of primary care providers, changing reimbursement structures, movement from inpatient to community-based models of care, an aging population, and health care reform lead to increased numbers of patients seeking care. All of these phenomena have a part in creating a health care landscape that requires industry leaders enlist innovative strategies to meet the health care needs of their communities. Delivery of high-quality, efficient care by qualified providers is essential for the success of any health care system. Partnerships between health systems and academic centers of learning to develop a pipeline of providers is one inventive approach that can address primary care workforce needs. The purpose of this article was to share an example of an academic/health care system partnership to address primary care workforce needs in a rural Midwestern region.