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Latest News

Nurse Practitioners Offer Better Care

by Janis Leibold, Assistant Editor, Fibromyalgia Network
Posted: June 30, 2011

Are Nurse Practitioners (NPs) ready to take on the nation's shortage of primary care physicians? Around the country, NPs believe they are ready to step up and do the job they were trained for. But state-to-state differences in regulations and practices have created huge barriers that hamper the NPs' performance and delay or deter patient care. In addition, the general public is not sure what an NP does.

With primary care facing a shortage crisis in the U.S., the need for more healthcare options is crucial. In research by Thomas Bodenheimer, M.D., M.P.H., today's medical students are more reluctant to go into primary care because of higher workloads and lower incomes compared to specialty medicine.1 And with healthcare reform expected to increase access to primary care for 32 million more Americans in the next few years, only 7 percent of fourth-year medical students in a 2010 survey plan to go into this field.

"NPs are well positioned to be part of the solution to issues of access to primary care," said Joanne M. Pohl, Ph.D. and Board Certified NP, in an article written by Laura A. Stokowski, R.N., M.S., for Medscape News.2 "Forty years of evidence confirm that NPs provide high-quality, cost-effective care and can contribute significantly to narrowing the primary care gap. There is no place for limitations on practice or other regulations that are not based on evidence."

Research led by Marielle E. Kroese, M.Sc., provides evidence that supports specialized nurses in primary care.3 Her team in the Netherlands did a study of 193 patients suspected of having fibromyalgia who were referred for diagnosis and treatment to a rheumatology clinic. Patients in the study were randomly divided and assigned to see either specialized rheumatology nurses or a rheumatologists (M.D.). The researchers wanted to compare patient satisfaction and costs between the care providers.

Initially, patients were able to get an appointment with the nurses within three weeks compared to three months for the rheumatologists. Actually, eight patients assigned to the rheumatologists dropped out of the study because of the long wait time.

Patients were seen one week after their first consultation, at three weeks, six weeks, and nine months later. About 75 percent of patients seen by a rheumatologist and 92 percent of those seen by the nurses were diagnosed with fibro. (All patients confirmed by the nurses with fibro were seen and received further confirmation from a rheumatologist.) Regardless of diagnosis, all the patients filled out questionnaires every two weeks during the study concerning their health, treatments, satisfaction with their care provider, and ability to function. Patients were also required to maintain a record of medical expenses.

After nine months, both patient groups reported to be in similar heath. However, the patients seeing the nurses were more satisfied and had better functionality with less cost throughout the study. Specifically, patients rated the nurses better in all nine patient-satisfaction categories including: taken seriously, understanding, time spent with nurse, paying attention to the social aspects of the illness, and giving clear information and advice. The research estimates that the average costs including medical and loss of productivity at work and home amounted to $5,595 per patient seen by a nurse compared to $7,690 per rheumatology patient. Some of this difference is accounted for by the patients who reported not being productive in the three months they had to wait for their initial appointment with the rheumatologist.

"The nurse-led diagnostic process can be recommended from a healthcare and societal perspective," said Kroese. "Patients in the nurse group were significantly more satisfied. Total healthcare costs and patient and family costs were significantly lower in the nurse group. Also costs from a societal perspective including absenteeism from work were lower."

Where do you go from here? Check your insurance list of providers for nurse practitioners. If none are listed, don't dismay. You may need to print the list of nearby primary care providers and call around to find out if an NP works in the doctor's office. The M.D.'s name may be on the door (and on the billing paperwork), but research shows that an NP may be your best option for fibromyalgia care.

What is a Nurse Practitioner?

An NP is a registered nurse who has advanced education and clinical training in a health care specialty and can serve as a primary health care provider for children and adults.

They should not be confused with Physician Assistants (PAs) who are always required to work under a doctor’s supervision. NPs are trained in many health care services, such as physical exams, family planning, diagnosing and treating acute and chronic illnesses, psychological counseling, and health education.

In some states, NPs can prescribe certain medications and medical equipment. But in most states their assessments, treatments, prescriptions, and what care they can provide is limited and must be approved by a medical doctor to receive patient insurance coverage. Rules and regulations for NPs differ at every level and every state, causing NPs to jump thorough hoops that delay patient care.

1. Bodenheimer T, Hoangmai PH. Health Aff 29(5) 799-805, 2010.
2. Stokowski L. Medscape Ask the Experts The Nurse Practitioner Will See you Now, June 29, 2010.
3. Kroese ME, et al. J Rheumatol [Epub ahead of print] April 2011.

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