Community Health Sciences, University of Nevada, Reno, Nevada, USA.
Nevada Department of Health and Human Services, Carson City, Nevada, USA.
J Epidemiol Community Health. 2019 Mar;73(3):278-284. doi: 10.1136/jech-2018-210709. Epub 2019 Jan 11.
Underserved women (rural, minority or poor) are disproportionally diagnosed with late-stage cervical cancer, indicative of inadequate access to, and use of, preventative healthcare. The Institute of Medicine (IOM) has proposed that nurse practitioners (NP) can address provider shortages among underserved populations, but to reduce shortages, scope-of-practice laws that restrict the delivery of care, must be revised. We examined the IOM recommendation of NP expanded scope-of-practice laws on reducing the disparity of underserved women diagnosed with late-stage cervical cancer.
We examined the cohort of 10 673 women diagnosed with cervical cancer between 2010 and 2014 and reported to the Surveillance, Epidemiology and End Results cancer registry. We linked state-level laws regarding NP scope-of-practice to patients with cancer by their state of residence, diagnosis date and law enactment date. Hierarchical regression was used to explore NP full scope-of-practice law's impact on late-stage cancer diagnoses considering the moderating effect of women living in medically underserved areas. We adjusted for known confounders available in this population-based data set.
Medically underserved women living in states with laws that restrict NP full scope-of-practice are twofold more likely to be diagnosed with late-stage cancer; adjusted OR and 95% CI (OR 2.08, 95% CI 1.4 to 3.1). These disparities were not observed among underserved women living in areas NP full scope-of-practice laws (OR 0.95, 95% CI 0.7 to 1.3).
NP full scope-of-practice laws could provide a pragmatic and cost-effective solution to healthcare provider shortages associated with late stage of cervical cancer diagnoses among underserved women.
服务不足的女性（农村、少数民族或贫困）被诊断为晚期宫颈癌的比例不成比例，这表明她们获得和使用预防保健服务的机会不足。美国国家医学科学院（IOM）曾提出，执业护士（NP）可以解决服务不足人群中医生短缺的问题，但要减少短缺，必须修改限制护理服务范围的执业范围法律。我们研究了 IOM 关于扩大 NP 执业范围法律以减少服务不足的女性被诊断为晚期宫颈癌的差异的建议。
我们检查了 2010 年至 2014 年间被诊断患有宫颈癌的 10673 名女性的队列，并向监测、流行病学和最终结果癌症登记处报告。我们将有关 NP 执业范围的州级法律与患者的癌症联系起来，根据她们的居住州、诊断日期和法律颁布日期。我们使用分层回归来探索 NP 全面执业范围法律对晚期癌症诊断的影响，同时考虑到女性居住在医疗服务不足地区的调节作用。我们根据本人群数据集中可用的已知混杂因素进行了调整。
居住在限制 NP 全面执业范围法律的州的医疗服务不足的女性被诊断为晚期癌症的可能性是两倍；调整后的 OR 和 95%CI（OR 2.08，95%CI 1.4 至 3.1）。在 NP 全面执业范围法律的地区，这些差异在服务不足的女性中并未观察到（OR 0.95，95%CI 0.7 至 1.3）。
NP 全面执业范围法律可能为解决与服务不足的女性宫颈癌晚期诊断相关的医疗保健提供者短缺问题提供一种实用且具有成本效益的解决方案。
