scholarly journals Primary Care Physicians’, Nurse Practitioners’ and Physician Assistants’ Knowledge, Attitudes and Beliefs Regarding COPD: 2007 to 2014

2016 ◽  
Vol 3 (3) ◽  
pp. 628-635
Author(s):  
Barbara Yawn ◽  
Peter Wollan ◽  
Kyle Textor ◽  
Roy Yawn
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
Attitudes And Beliefs

Primary Care and Physician Extenders in Affluent Countries

1977 ◽  
Vol 7 (4) ◽  
pp. 545-555 ◽  
Author(s):  
Milton I. Roemer
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
The United States ◽  
Industrialized Countries ◽  
Major Response ◽  
Urban And Rural Areas ◽  
Physician Extenders

The worldwide growth of specialization in medicine has led to a perceived shortage of primary care. A major response in the United States has been the training of physician extenders (both physician assistants and nurse practitioners). Other industrialized countries have rejected this approach, in favor of strengthening general medical practice through continuing education, provision of ancillary personnel, use of health centers, and by other methods. Developing countries use doctor-substitutes as a reasonable adjustment to their lack of economic resources. All countries use ancillary personnel for selected procedures, such as midwifery, which involve only limited judgment and decision making. The American strategy on use of doctor-substitutes for primary care, however, follows from unwillingness to train greater numbers of primary care physicians and to require them to serve in places of need. This results in an inequitable concentration of doctor-substitutes on service to the poor in both urban and rural areas.

Health care costs associated with primary care physicians versus nurse practitioners and physician assistants

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Suja S. Rajan ◽  
Julia M. Akeroyd ◽  
Sarah T. Ahmed ◽  
David J. Ramsey ◽  
Christie M. Ballantyne ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Costs ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
Care Costs

scholarly journals Advanced Practice Clinicians Providing an Increased Share of Primary Care in Skilled Nursing Facilities, 2008-2016

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 87-87
Author(s):  
Elizabeth White ◽  
Cyrus Kosar ◽  
Momotazur Rahman
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Medicare Beneficiaries ◽  
Medical Providers ◽  
Skilled Nursing ◽  
For Profit

Abstract Rising care complexity in skilled nursing facilities (SNFs), coupled with growing shortages of geriatricians and other primary care physicians able to see SNF patients, have increased demand for nurse practitioners and physician assistants (NP/PAs). We used 2008-2016 Medicare Part A and B claims and nursing home assessment data to describe longitudinal trends in NP/PA practice in SNFs. We identified 8,877,094 SNF post-acute primary care visits for 1,494,113 Medicare beneficiaries. The total number of visits increased from 850,285 in 2008 to 1,189,553 in 2016. The share of visits by NP/PAs rose significantly over time, from 24% of visits in 2008 to 43% in 2016. 71% of SNFs (n=10,139) used NP/PAs in 2016, up from 46% (n=6,696) in 2008. The number of NP/PAs practicing in SNFs more than doubled, from 4,472 clinicians in 2008 to 10,000 in 2016. The number of physicians practicing in SNFs declined from 26,297 in 2008 to 19,745 in 2016. NP/PAs represented 14% of all SNF medical providers in 2008 and 34% of providers in 2016. In 2016, 48% of NP/PAs were SNFists (i.e. >90% of visits billed in SNF), vs. only 11% of physicians. SNFs with NP/PAs are on average larger, more likely urban, for profit, and care for larger populations of racial minorities, than SNFs without NP/PAs. SNFs with NP/PAs also have more short-stay Medicare residents, more admissions, higher nurse and rehab staffing levels, and higher case mix. These findings show that NP/PAs are taking on increasingly prominent roles as medical providers in SNFs.

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 A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours? (Preprint)

2019 ◽  
Author(s):  
Frederick North ◽  
Kristine E Luhman ◽  
Eric A Mallmann ◽  
Toby J Mallmann ◽  
Sidna M Tulledge-Scheitel ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Care Physician ◽  
Work Hours ◽  
Patient Portal ◽  
Secure Messaging ◽  
After Hours ◽  
Over Time

BACKGROUND Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours. OBJECTIVE This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours. METHODS We collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours). RESULTS Portal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent. CONCLUSIONS Provider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume.

Healthcare Providers Face Numerous Challenges in Treating Patients with Psoriasis: Results from a Mixed-Methods Study

2021 ◽  
pp. 247553032110628
Author(s):  
Suzanne Murray ◽  
Jeffrey Crowley ◽  
Melinda J. Gooderham ◽  
Alan Kivitz ◽  
Vinod Chandran ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Nurse Practitioners ◽  
Paradigm Shift ◽  
Primary Care Physicians ◽  
Healthcare Providers ◽  
Continuing Professional Development ◽  
Physician Assistants ◽  
Care Providers ◽  
Starting Point ◽  
Practice Gaps

Background The paradigm shift toward biologic medications in psoriasis care requires healthcare providers (HCPs) to become acquainted with mechanisms of action and safety profiles of these new treatments to confidently use them in practice. A better understanding of this paradigm shift is necessary to provide adequate education for HCPs in psoriasis care. Objectives This study assessed clinical practice gaps and challenges experienced by HCPs caring for patients with psoriasis. Methods A mixed-methods approach was used to identify practice gaps and clinical challenges of dermatologists, rheumatologists, primary care physicians, physician assistants, and nurse practitioners with various levels of clinical experience in academic and community-based settings. Qualitative and quantitative data were collected sequentially. Interviews were transcribed and thematically analyzed. Results A total of 380 psoriasis care providers in Canada and the US participated in this study. Analysis revealed challenges in establishing an accurate diagnosis of psoriasis (including screening for sub-type and distinguishing psoriasis from other skin conditions), selecting treatment (particularly regarding recently approved treatments), monitoring side effects, and collaborating with other HCPs involved in psoriasis care. Conclusion These findings highlight educational needs of HCPs involved in psoriasis care that could have repercussions on accurate and timely diagnosis of the condition, treatment initiation, side effect monitoring, and continuity of care. Findings provide a starting point for clinicians to reflect on their practice and for the improvement of continuing professional development interventions that would bridge these gaps.

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