Nurs Res. 2024;73(5):E212-E220. doi: 10.1097/NNR.0000000000000758. Epub 2024 Jun 26.
Patients with multiple chronic conditions often have many care plans, polypharmacy, and unrelieved symptoms that contribute to high emergency department and hospital use. High-quality primary care delivered in practices that employ nurse practitioners can help prevent the need for such acute care services. However, such practices located in primary care health professional shortage areas face challenges caring for these patients because of higher workloads and fewer resources.
We examined differences in hospitalization and emergency department use among patients with multiple chronic conditions who receive care from practices that employ nurse practitioners in health professional shortage areas compared to practices that employ nurse practitioners in non-health professional shortage areas.
We performed an analysis of Medicare claims, merged with Health Resources and Services Administration data on health professional shortage area status in five states. Our sample included 394,424 community-dwelling Medicare beneficiaries aged ≥65 years, with at least two of 15 common chronic conditions who received care in 779 practices that employ nurse practitioners. We used logistic regression to assess the relationship between health professional shortage area status and emergency department visits or hospitalizations.
We found a higher likelihood of emergency department visits among patients in health professional shortage areas compared to those in non-health professional shortage areas and no difference in the likelihood of hospitalization.
Emergency department use differences exist among older adults with multiple chronic conditions receiving care in practices that employ nurse practitioners in health professional shortage areas, compared to those in non-health professional shortage areas. To address this disparity, the health professional shortage area program should invest in recruiting and retaining nurse practitioners to health professional shortage areas to ease workforce shortages.
患有多种慢性病的患者通常有许多护理计划、多种药物治疗和未缓解的症状，这导致他们频繁使用急诊室和医院。在雇佣护士从业者的实践中提供高质量的初级保健可以帮助预防对这些急性护理服务的需求。然而，位于初级保健卫生专业人员短缺地区的此类实践由于工作量较大且资源较少，在照顾这些患者方面面临挑战。
我们研究了在卫生专业人员短缺地区雇佣护士从业者的实践中接受护理的患有多种慢性病的患者与在非卫生专业人员短缺地区雇佣护士从业者的实践中接受护理的患者相比，在住院和急诊室使用方面的差异。
我们对 Medicare 索赔进行了分析，并与五个州的卫生资源和服务管理局关于卫生专业人员短缺地区地位的数据进行了合并。我们的样本包括 394424 名居住在社区的 Medicare 受益人，年龄≥65 岁，至少有 15 种常见慢性病中的两种，并在 779 家雇佣护士从业者的实践中接受护理。我们使用逻辑回归评估卫生专业人员短缺地区地位与急诊就诊或住院之间的关系。
我们发现，与非卫生专业人员短缺地区相比，卫生专业人员短缺地区的患者急诊就诊的可能性更高，而住院的可能性没有差异。
与在非卫生专业人员短缺地区的实践中接受护理的患有多种慢性病的老年患者相比，在卫生专业人员短缺地区的实践中接受护理的患者在急诊就诊方面存在差异。为了解决这一差异，卫生专业人员短缺地区计划应投资于在卫生专业人员短缺地区招聘和留住护士从业者，以缓解劳动力短缺。
