Muench Ulrike, Quan Amy, de Lisser Rosalind, Bates Timothy, Spetz Joanne
Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA 94158, United States.
Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, CA 94158, United States.
Health Aff Sch. 2024 Nov 19;2(12):qxae153. doi: 10.1093/haschl/qxae153. eCollection 2024 Dec.
Nurse practitioners (NPs) are important providers of primary care to underserved populations, particularly in areas with lower physician supply. In 2023, California implemented new regulations aimed at improving access to care, especially primary care services, by providing a pathway for NPs to practice without formal supervision after 3 years of practice and without any physician relationship after 5 years of practice. This study used data from a representative survey of California-licensed NPs fielded in late 2022 to examine NPs' current practice and intentions following implementation of the new regulations. Results indicated notable differences in the characteristics of NPs who are considering establishing an independent primary care practice and who are considering changing their practice to serve more Medicaid enrollees at the advent of expanded scope of practice. The strong association between racial/ethnic identity and greater interest in practice change suggests that after the elimination of physician collaboration requirements, increasing the diversity of the NP workforce may be one of the most important strategies for increasing access to care for Californians and especially for people receiving Medicaid.
执业护士是为服务不足人群提供初级保健的重要提供者，尤其是在医生供应较少的地区。2023年，加利福尼亚州实施了新规定，旨在通过为执业护士提供一条途径，使其在执业3年后无需正式监督即可执业，在执业5年后无需与任何医生建立关系，从而改善医疗服务的可及性，特别是初级保健服务。本研究使用了2022年末对加利福尼亚州持牌执业护士进行的一项代表性调查的数据，以检查新规定实施后执业护士的当前执业情况和意向。结果表明，在扩大执业范围之际，考虑建立独立初级保健执业机构的执业护士和考虑改变执业方式以服务更多医疗补助受助人的执业护士在特征上存在显著差异。种族/族裔身份与更大的执业改变兴趣之间的强烈关联表明，在取消医生合作要求后，增加执业护士劳动力的多样性可能是增加加利福尼亚人尤其是医疗补助受助人获得医疗服务机会的最重要策略之一。
