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Support to practice independently allows NPs to provide ongoing primary care

Lusine Poghosyan

Nurse practitioners who were supported by their health care organization as independent primary care providers were more likely to have their own panel of patients to whom they provided ongoing primary care — a strategy that can aid in filling the primary care gap, according to research published in the International Journal of Nursing Studies.

“Health care systems globally are facing challenges to deliver timely, high quality and cost effective primary care,” Lusine Poghosyan, PhD, assistant professor at Columbia University School of Nursing, New York, and colleagues wrote. “The growing shortage of primary care physicians is a contributing factor to such imbalance in the demand for care and supply of primary care providers.”

Better utilization of nurse practitioners (NPs) may help meet the demand for primary care services, according to the researchers.

Poghosyan and colleagues sought to determine the role of NPs in delivering care within primary care organizations, specifically whether they deliver ongoing continuous care or episodic care to patients, as well as how work environments influence such roles. They distributed a cross-sectional survey to 807 NPs from the Massachusetts Provider Database who provided care in one of 163 primary care organizations that had one to 12 NPs on staff. The survey was completed and returned by 314 NPs (40% response rate).

To measure the role of the NP, participants were asked to report whether they had their own patient panel to whom they delivered ongoing continuous care. The researchers used the Nurse Practitioner Primary Care Organizational Climate Questionnaire to measure work environment. On the questionnaire, participants rated characteristics of their organizations, such as their relationships with physicians and administrators, support received to practice independently, and visibility within their organizations.

Data from the survey indicated that approximately 45% of NPs served as PCPs and delivered ongoing continuous care to their own patient panel. Support for independent practice positively and significantly affected NPs role in care delivery (RR = 2.33; 95% CI, 1.06-5.13). A one-unit increase on the Organization-level Independent Practice and Support subscale increased the likelihood of NPs acting as PCPs with their own patient panel by twofold.

“Our study shows that in organizations where NPs ability to deliver care independently is supported, NPs are more likely to have their own patient panel to whom they deliver continuous ongoing primary care,” Poghosyan told Healio Internal Medicine. “One of the key aspects of effective primary care is to develop a continuous and sustainable relationship between the patient and the PCP, which extends beyond a single visit for urgent care needs.

“Many NPs are taking on PCP roles, which helps to meet the growing demand for primary care services in this country,” she continued. “Employers should take actions to create an environment that fosters the relationship between NPs and their patients by allowing NPs to have their own patient panels with whom they treat continuously vs. only seeing patients for single visit episodic care. NPs who have their own patient panels have the opportunity to become familiar with the needs of their patients and to develop a trusting relationship with them. This, in turn, creates more opportunities to educate and teach patients about good health care practices, which will help prevent diseases.” – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.