Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners?

2016 ◽  
Vol 73 (1) ◽  
pp. 240-252 ◽  
Author(s):  
May Nawal Lutfiyya ◽  
Lisa Tomai ◽  
Bianca Frogner ◽  
Frank Cerra ◽  
Daniel Zismer ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Diabetes Management ◽  
Medicare Patients

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

scholarly journals Exploring the interpersonal collaboration during the integration of diabetes teams into primary care.

2021 ◽  
Author(s):  
Enza Gucciardi ◽  
Sherry Espin ◽  
Antonia Morganti ◽  
Linda Dorado
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Diabetes Management ◽  
Interprofessional Collaboration ◽  
Diabetes Education ◽  
Knowledge Exchange ◽  
Management Training ◽  
New Ways Of Working ◽  
Positive Effects ◽  
Diabetes Educators

Background Specialised diabetes teams, specifically certified nurse and dietitian diabetes educator teams, are being integrated part-time into primary care to provide better care and support for Canadians living with diabetes. This practice model is being implemented throughout Canada in an effort to increase patient access to diabetes education, self-management training, and support. Interprofessional collaboration can have positive effects on both health processes and patient health outcomes, but few studies have explored how health professionals are introduced to and transition into this kind of interprofessional work. Method Data from 18 interviews with diabetes educators, 16 primary care physicians, 23 educators’ reflective journals, and 10 quarterly debriefing sessions were coded and analysed using a directed content analysis approach, facilitated by NVIVO software. Results Four major themes emerged related to challenges faced, strategies adopted, and benefits observed during this transition into interprofessional collaboration between diabetes educators and primary care physicians: (a) negotiating space, place, and role; (b) fostering working relationships; (c) performing collectively; and (d) enhancing knowledge exchange. Conclusions Our findings provide insight into how healthcare professionals who have not traditionally worked together in primary care are collaborating to integrate health services essential for diabetes management. Based on the experiences and personal reflections of participants, establishing new ways of working requires negotiating space and place to practice, role clarification, and frequent and effective modes of formal and informal communication to nurture the development of trust and mutual respect, which are vital to success.

Coordinated Primary Care (“Medical Home” Model)

2009 ◽  
Vol 2 (2) ◽  
pp. 60-64 ◽  
Author(s):  
Mary Petermann Garnica
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Medical Home ◽  
Primary Care Physicians ◽  
Team Leaders ◽  
Care Nurse ◽  
Medical Home Model ◽  
Primary Care Practices ◽  
Primary Care Medical Home

Health care is inaccessible and too expensive for a large segment of the U.S. population. In addition, the past decade has produced many reports of significant problems related to safety, quality, and effectiveness in U.S. health care. The future of primary care is in question because of a current and projected worsening shortage of primary care physicians. A physician-led coordinated primary care model has been endorsed by major physicians groups as having the potential to address many of these problems. The model, also known as the “medical home,” has gained momentum and appears likely to play a central role as the nation moves forward to reform health care. Nurse practitioners have traditionally practiced “coordinated primary care” and are ideally suited to lead practices adopting this model of care. This article provides rationale for nurse practitioners to be fully recognized as team leaders of coordinated primary care practices.

scholarly journals An Overview of Diabetes Management in Schizophrenia Patients: Office Based Strategies for Primary Care Practitioners and Endocrinologists

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Aniyizhai Annamalai ◽  
Cenk Tek
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Behavioral Interventions ◽  
Diabetes Management ◽  
Psychotropic Medications ◽  
Antipsychotic Medications ◽  
Multiple Factors ◽  
Metabolic Conditions ◽  
Treatment Of Diabetes ◽  
Primary Care Practitioners

Diabetes is common and seen in one in five patients with schizophrenia. It is more prevalent than in the general population and contributes to the increased morbidity and shortened lifespan seen in this population. However, screening and treatment for diabetes and other metabolic conditions remain poor for these patients. Multiple factors including genetic risk, neurobiologic mechanisms, psychotropic medications, and environmental factors contribute to the increased prevalence of diabetes. Primary care physicians should be aware of adverse effects of psychotropic medications that can cause or exacerbate diabetes and its complications. Management of diabetes requires physicians to tailor treatment recommendations to address special needs of this population. In addition to behavioral interventions, medications such as metformin have shown promise in attenuating weight loss and preventing hyperglycemia in those patients being treated with antipsychotic medications. Targeted diabetes prevention and treatment is critical in patients with schizophrenia and evidence-based interventions should be considered early in the course of treatment. This paper reviews the prevalence, etiology, and treatment of diabetes in schizophrenia and outlines office based interventions for physicians treating this vulnerable population.

Association of State-Level Restrictions in Nurse Practitioner Scope of Practice With the Quality of Primary Care Provided to Medicare Beneficiaries

2017 ◽  
Vol 76 (5) ◽  
pp. 597-626 ◽  
Author(s):  
Jennifer Perloff ◽  
Sean Clarke ◽  
Catherine M. DesRoches ◽  
Monica O’Reilly-Jacob ◽  
Peter Buerhaus
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Primary Care Physicians ◽  
Scope Of Practice ◽  
Care Nurse ◽  
State Regulations ◽  
Primary Care Nurse ◽  
Quality Of Primary Care

Context: State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. Method: This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care. Findings: Results show a lack of consistent association between quality of primary care provided by NPs and state SoP restrictions. Conclusion: State regulations restricting NP SoP do not improve the quality of care.

scholarly journals Survivorship Care Focus Group Discussions for Breast Cancer Survivors and Primary Care Clinicians

2021 ◽  
pp. 1-4
Author(s):  
Hillary Klonoff-Cohen ◽  
Hillary Klonoff-Cohen ◽  
Mounika Polavarapu
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Focus Group ◽  
Cancer Survivors ◽  
Nurse Practitioners ◽  
Late Effects ◽  
Primary Care Physicians ◽  
Breast Cancer Survivors ◽  
Survivorship Care ◽  
Psychological Consequences

Purpose: This is the first pilot study to examine survivors’ experiences and primary care physicians and nurse practitioners’ knowledge and behaviour practices with respect to late effects (e.g., fatigue, chemobrain, lymphodema, cardiac problems, reproductive, infertility and sexual health issues, bone problems, and pain). Methods: Two separate focus groups consisting of 5 breast cancer survivors and 5 primary care physicians and nurse practitioners recruited from a local hospital in Central Illinois answered predetermined questions about cancer survivorship care. We intentionally limited the sample in order to conduct a detailed discussion (90 minutes) to gain every participant’s perspective. Results: Breast cancer survivors expressed a void in discussion and lack of knowledge among their primary care physicians regarding late effects as well as psychological consequences, referrals to support groups, and availability of resources (e.g., finances), thereby negatively affecting survivors’ quality of life. A primary care clinician (PCC) focus group revealed a service gap for mental health services for all patients, knowledge deficit about late effects, and lack of awareness of patient resources. Both cancer survivors and PCCs were extremely supportive about a shared care survivorship model between oncology and primary care. All focus group participants were unequivocally receptive about enhancing survivorship care throughout a cancer survivor’s lifetime. Conclusion: Complementing cancer survivorship care with primary care clinicians in the areas of late effects, in addition to psychological consequences, screening, and lifestyle habits will enhance a cancer survivor’s health-related quality of life.

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