University of Texas Medical Branch, Galveston, TX, USA.
Health Aff (Millwood). 2013 Jul;32(7):1236-43. doi: 10.1377/hlthaff.2013.0072.
The use of nurse practitioners (NPs) is one way to address the shortage of physician primary care providers. NP training programs and the number of practicing NPs have increased in the past two decades. However, regulations limiting their scope of practice vary greatly by state. We assessed the impact of state regulations on the increase in care provided by NPs in the United States, using a 5 percent national sample of Medicare beneficiaries. We found that between 1998 and 2010 the number of Medicare patients receiving care from NPs increased fifteenfold. By 2010 states with the least restrictive regulations of NP practice had a 2.5-fold greater likelihood of patients' receiving their primary care from NPs than did the most restrictive states. Relaxing state restrictions on NP practice should increase the use of NPs as primary care providers, which in turn would reduce the current national shortage of primary care providers.
使用执业护士（NPs）是解决初级保健医生短缺的一种方法。过去二十年中，NP 培训计划和执业 NP 的数量有所增加。然而，各州对其执业范围的规定差异很大。我们使用 Medicare 受益人的全国 5%抽样调查评估了州法规对美国由 NPs 提供的护理增加的影响。我们发现，1998 年至 2010 年间，接受 NPs 护理的 Medicare 患者数量增加了 15 倍。到 2010 年，对 NP 实践限制最少的州的患者接受 NP 初级保健的可能性是限制最严格的州的两倍半。放宽对 NP 实践的州限制应会增加 NPs 作为初级保健提供者的使用，从而缓解当前初级保健提供者短缺的现状。
