执业范围护士从业者和遵医嘱用药治疗慢性病初级保健。
Scope-of-Practice for Nurse Practitioners and Adherence to Medications for Chronic Illness in Primary Care.
机构信息
Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
Philip R. Lee Institute for Health Policy Studies, Department of Community and Family Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
出版信息
J Gen Intern Med. 2021 Feb;36(2):478-486. doi: 10.1007/s11606-020-05963-3. Epub 2020 Jun 24.
BACKGROUND
Nonadherence to medications is costly and improving adherence is difficult, requiring multifactorial solutions, including policy solutions.
OBJECTIVE
The purpose of this study is to evaluate the effect of one policy strategy on medication adherence. Specifically, we examine the effect on adherence of expanding scope-of-practice regulations for nurse practitioners (NPs) to practice and prescribe without physician supervision.
DESIGN
We conducted three difference-in-difference multivariable analyses of commercial insurance claims.
PARTICIPANTS
Patients who filled at least two prescriptions in one of three chronic therapeutic medications: anti-diabetics (n = 514,255), renin angiotensin system antagonists (RASA) (n = 1,679,957), and anti-lipidemics (n = 1,613,692).
MAIN MEASURES
Medication adherence was measured as the proportion of days covered (PDC). We used one continuous (PDC 0-1) and one binary outcome (PDC of > .8), the latter indicating good adherence.
KEY RESULTS
Patients taking anti-diabetic medications had a 1.9 percentage point higher medication adherence rate (p < 0.05) and a 2.7 percentage point higher probability of good adherence (p < 0.001) in states that expanded NP scope-of-practice. Medication adherence for patients taking RASA was higher by 2.3 percentage points (p < 0.001) and 3.4 percentage points (p < 0.01) for both measures, respectively. Patients taking anti-lipidemics saw a smaller, but statistically insignificant, improvement in adherence.
CONCLUSIONS
Results indicate that scope-of-practice regulations that allow NPs to practice and prescribe without physician oversight are associated with improved medication adherence. We postulate that the mechanism for this effect is increased access to health care services, which in turn increases access to prescriptions. Our results suggest that policies allowing NPs to maximally use their skills can be beneficial to patients.
背景
药物依从性差且难以改善，需要多因素解决方案，包括政策解决方案。
目的
本研究旨在评估一项政策策略对药物依从性的影响。具体来说，我们研究扩大执业范围的规定对执业护士（NP）在没有医生监督的情况下进行实践和开处方的影响。
设计
我们进行了三次差异中的差异多变量分析，涉及商业保险索赔。
参与者
至少在三种慢性治疗性药物中的两种药物中服用药物的患者：抗糖尿病药物（n=514255）、肾素-血管紧张素系统拮抗剂（RASA）（n=1679957）和抗血脂药物（n=1613692）。
主要措施
药物依从性测量为比例覆盖天数（PDC）。我们使用了一个连续的（PDC 0-1）和一个二进制结果（PDC>0.8），后者表示良好的依从性。
主要结果
在扩大 NP 执业范围的州，服用抗糖尿病药物的患者药物依从性提高了 1.9 个百分点（p<0.05），良好依从性的概率提高了 2.7 个百分点（p<0.001）。服用 RASA 的患者的药物依从性分别提高了 2.3 个百分点（p<0.001）和 3.4 个百分点（p<0.01）。服用降脂药的患者的依从性略有提高，但无统计学意义。
结论
结果表明，允许 NP 在没有医生监督的情况下进行实践和开处方的执业范围规定与提高药物依从性有关。我们推测这种效果的机制是增加获得医疗服务的机会，从而增加获得处方的机会。我们的结果表明，允许 NP 最大限度地利用其技能的政策对患者有益。
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