Cohen S S, Mason D J, Arsenie L S, Sargese S M, Needham D
Center for Health Policy, Yale University School of Nursing, New Haven, Connecticut, USA.
Nurse Pract. 1998 Jun;23(6):48, 54, 57-60 passim.
Decades of practice and research suggest that nurse practitioners (NPs) provide cost-effective and high-quality care. Managed care's emphasis on prevention and cost savings led some policy makers to view NPs as a way to meet the need for primary care providers. However, access to and utilization of NPs has increasingly been controlled by managed care organizations (MCOs) through their selection of providers for primary care panels. This study employed qualitative methodology to examine NPs' experiences with MCOs. Three focus groups, comprising 27 NPs in New York and Connecticut, revealed NPs' mixed reactions to managed care and a range of sentiments regarding NPs' efforts to be listed as primary care providers. The results reflected NPs' concerns about their perceived "invisibility," as well as their sense of "invincibility" in the ways in which NPs are responding to the barriers posed by MCOs. They identified barriers to, as well as ways to facilitate, being listed by MCOs, and described the importance of NPs working individually and collectively in negotiating with MCOs.
数十年的实践和研究表明，执业护士（NPs）能提供具有成本效益且高质量的护理服务。管理式医疗对预防和成本节约的重视，使得一些政策制定者将执业护士视为满足初级护理提供者需求的一种途径。然而，管理式医疗组织（MCOs）通过挑选初级护理小组的提供者，对执业护士的可及性和使用情况的控制越来越多。本研究采用定性方法来考察执业护士与管理式医疗组织的经历。三个焦点小组，由纽约和康涅狄格州的27名执业护士组成，揭示了执业护士对管理式医疗的复杂反应，以及他们对被列为初级护理提供者所做努力的一系列看法。结果反映出执业护士对自身被视为“隐形人”的担忧，以及他们在应对管理式医疗组织所带来的障碍时的“无敌”感。他们确定了被管理式医疗组织列入名单的障碍以及促进因素，并描述了执业护士单独和集体与管理式医疗组织谈判的重要性。
