Peterson Lars E, Blackburn Brenna, Petterson Stephen, Puffer James C, Bazemore Andrew, Phillips Robert L
The American Board of Family Medicine, Lexington, Kentucky; Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky.
J Rural Health. 2014 Summer;30(3):227-34. doi: 10.1111/jrh.12053. Epub 2013 Dec 15.
Facing rising numbers of insured with implementation of the Affordable Care Act, policy makers are interested in building teams of providers that can accommodate a growing demand for primary care services. Nurse Practitioners (NPs), Physician Assistants (PAs), and Certified Nurse Midwives (CNMs) already augment the physician workforce, particularly in rural areas. Our objective was to determine what physician and areal-level characteristics were associated with working with NPs, PAs or CNMs.
The sample consisted of a convenience sample of physicians through the American Board of Family Medicine (ABFM) website in the fall of 2011. We linked these data to demographic and practice information collected by the ABFM and with provider information supplied from the National Provider Identifier file aggregated at the Primary Care Service Area level. Hierarchical logistic regression models were used to determine variables associated with working with NPs, PAs, or CNMs.
Of the 3,855 family physicians in our sample, 60% reported routinely working with NPs, PAs, or CNMs. In regression analysis, characteristics positively associated with working with NPs, PAs, or CNMs were providing gynecological care (Odds Ratio = 1.23 [95% confidence interval, 1.06-1.42]), multispecialty group practice (OR = 1.72 [1.36-2.18]), any rural setting, and higher availability of PAs (OR = 1.40 [1.10-1.79]). Restrictive NP scope of practice laws failed to reach significance (OR = 0.86 [0.71-1.05]).
This study suggests that the number of family physicians routinely working with NPs, PAs, and CNMs continues to increase, which may allow for improved access to health care, particularly in rural areas.
随着《平价医疗法案》的实施，参保人数不断增加，政策制定者们希望组建能够满足日益增长的初级保健服务需求的医疗服务团队。执业护士（NPs）、医师助理（PAs）和认证助产士（CNMs）已经在扩充医师队伍，尤其是在农村地区。我们的目标是确定与NPs、PAs或CNMs合作的医师及地区层面的特征。
样本是通过2011年秋季美国家庭医学委员会（ABFM）网站选取的便利样本医师。我们将这些数据与ABFM收集的人口统计学和执业信息以及从初级保健服务区层面汇总的国家提供者识别码文件提供的提供者信息相链接。使用分层逻辑回归模型来确定与NPs、PAs或CNMs合作相关的变量。
在我们样本中的3855名家庭医生中，60%报告经常与NPs、PAs或CNMs合作。在回归分析中，与NPs、PAs或CNMs合作呈正相关的特征包括提供妇科护理（优势比 = 1.23 [95%置信区间，1.06 - 1.42]）、多专科团体执业（OR = 1.72 [1.36 - 2.18]）、任何农村地区以及PA的可获得性更高（OR = 1.40 [1.10 - 1.79]）。限制NP执业范围的法律未达到显著水平（OR = 0.86 [0.71 - 1.05]）。
本研究表明，经常与NPs、PAs和CNMs合作的家庭医生数量持续增加，这可能有助于改善医疗服务的可及性，尤其是在农村地区。
