The Physician Assistant and Nurse Practitioner professions initially began in response to healthcare shortages after the Vietnam War in the 1960s. Highly trained combat medical personnel developed into highly skilled PAs, while during this same time nurses began advanced practices that ultimately evolved into the position of NPs. Since this time, the roles and responsibilities delegated to each of these fields have drastically evolved, and are expected to continue to do so in the face of current health care reform under President Obama's Patient Protection and Affordable Care Act initiated in 2010. Originally perceived as "understudies" to physicians, PAs and NPs have become much more trained in their expertise, respected in their roles, and autonomous in their practice. Due to this, it has been predicted that PAs and NPs will become the major primary care providers in the face of increasing demands in this area of medicine. Large numbers of aging populations and up to 32 million newly insured patients seeking healthcare, coupled with physician shortages, have increased demands on PAs and NPs to fill these employment gaps. As there has been an increased demand on the PA and NP profession, there has been a paralleled increase in the number of educational programs producing graduates, larger class sizes, and larger numbers of PAs and NPs entering the workforce. The problem is posed when PAs and NPs, who desire to pay off student loans quickly and, understandably, seek high wages and professional advancement, pursue specialty and subspecialty employment versus filling in primary care gaps as anticipated. As the roles of PAs and NPs change, and more is expected of them in terms of practice and reliability, there are barriers to their growth. Professional tensions between these providers and physicians, poor understanding of what roles PAs and NPs hold by the public, unequal reimbursement for comparable services, and strict state legislation that limits the scope of practice of both PAs and NPs all inhibit these healthcare professionals from practicing to their fullest potential. This, in turn, may hinder persons becoming PAs and NPs from funneling into the ever increasingly demanding primary care field of medicine, and may pose future problems as patient populations increase under the Affordable Care Act. This paper assesses the current roles and responsibilities of PAs and NPs, how each profession is expected to grow, and the evolution of these healthcare providers as the potential "solution" to primary care needs. Statistics regarding current distributions of PAs and NPs in practice, educational expansion, obstacles that these professions must overcome, and the capabilities of PAs and NPs alike are analyzed, and conclusions drawn on what the contributions of these healthcare professionals may be in the future. Overall, it is expected that PA and NP presence in the medical field will undoubtedly increase. Whether these professionals will serve as an adequate source of primary care providers in the face of increasing demands imposed by the Affordable Care Act is yet to be seen, however. Barriers including professional tensions, reimbursement policies, wages, and strict state restrictions on the scope of practice of these individuals will need to be addressed. While it is projected that PAs and NPs will "solve" the current and future primary care physician shortage, this fact truly remains to be seen.

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Class of 2009 Abstract / OBJECTIVES: The purpose of this study is to describe clinical pharmacist services in a nurse practitioner (NP) run clinic and how clinical pharmacists might influence prescribing. METHODS: The description of the clinical pharmacist services is based on a 12-week experience of a clinical pharmacist and senior student pharmacist working with the nurse practitioner and nurse practitioner students. A questionaire was developed and consisted of items relating to the nurse practitioners ability to identify possible interactions of OTC medications, herbals and prescription medications. In addition, the questionnare assessed the comfort level of NP’s taking a prescription medication history, checking a patient’s prescription formulary, and selecting appropriate medication therapies. The questionaire uses a retrospective pretest format and was tested as a method of collecting data on how a pharmacist influenced NP prescribing. The site selected for this study was the Arizona State University Center for Healthcare Innovation (ASU Center) located in the heart of Downtown Phoenix (3rd Ave and Van Buren). RESULTS: Only one nurse practitioner worked at the ASU Center. The facility is new to the neighborhood and does not see many patients. The nurse practitioner partner in this project responded that working with a clinical pharmacist on a regular basis, with more patients would definitely help her hone skills necessary to identify interactions and prescribe according to a patients formulary. CONCLUSIONS: Pharmacists provide value-added services in an ambulatory care clinic run by nurse practitioners and provide valuable education and consultation on drug interactions. Pharmacist influence can be measured successfully to using a questionnaire in a retrospective pretest-posttest study design.

The demands for high quality primary care have become strained by a deficit in the primary care physician supply and the complexity of delivering care to aging populations that are often living with complex co-morbidities. Provider co-management has emerged in practice to help alleviate some of the care delivery demands by having more than primary care provider (PCP) complete care management tasks for the same patient. There is extensive literature investigating two physicians co-managing patient care, and physician-physician assistant co-management, yet limited studies have investigated nurse practitioner (NP)-physician co-management. NPs currently are the fastest growing health care workforce in the United States. Several organizations support the expanded utilization of NPs in primary care. As more U.S. states are granting NPs independent scope of practice, which is free of physician oversight, the potential for NPs to co-manage patients with physicians, and alleviate some of the primary care strain, has increased. However, there are limited to no studies that have investigated NP-physician co-management in primary care. Further, there is a lack of evidence of PCP perspectives about co-managing care, its impact on patient and practice outcomes, or a tool to measure NP-physician co-management in practice or research. More evidence about NP-physician co-management is warranted and will be investigated in this dissertation. The purpose of this dissertation is to investigate NP-physician co-management in primary care by synthesizing the existing evidence, gathering data from PCPs about NP-physician co-management and to develop a valid and reliable tool to measure it. In Chapter 1, background of the current demands on primary care is presented and accompanied by a discussion about the need to expand the NP workforce in primary care to help meet the demand. Evidence about the history of provider co-management is presented and gaps in the literature are identified. Specific aims of the dissertation are introduced and tied to existing theoretical underpinnings. In Chapter 2, aim one of the dissertation is addressed by qualitatively obtaining data on the PCP perspective of NP-physician co-management. In Chapter 3, aim two of the dissertation is addressed. A systematic review of the literature was conducted to determine the effects of NP-physician co-management compared to a single physician delivering care. In Chapter 4, aim three is addressed. Based on the collective findings of Aim 1 and Aim 2, a new tool is developed and psychometrically tested to measure NP-physician co-management. Content validity and reliability testing of the tool is conducted. In Chapter 5, the results of the dissertation are synthesized. Practice, policy, and research implications are discussed, and strengths and limitations of the dissertation are presented.

Thesis (M.S.)--University of Nevada, Reno, 2005. / "May 2005." Includes bibliographical references (leaves 55-61). Online version available on the World Wide Web. Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2005]. 1 microfilm reel ; 35 mm.

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Asthma is a chronic disease that affects 8.4 million children in the United States (American Lung Association [ALA], 2007). Adolescents with asthma need tailored management of their care with attention given to particular developmental concerns. Standards of care, such as the National Heart, Lung, Blood Institute [NHLBI] 2007 asthma guidelines (NHLBI, 2007), exist to guide patient care and in this case, also address specific adolescent needs. Advanced practice nurses should incorporate "national standards of care as a framework for managing patient care" (American Association of Nurse Practitioners [AANP], 2007, p. 2). There is a lack of research about nurse practitioner use of standards of care, especially in caring for adolescents with asthma.The purpose of this practice inquiry was to explore patterns of practice and perceptions of practice by the nurse practitioners who care for adolescents with asthma, and to evaluate the current patterns of practice in comparison with national standards for providing care to adolescents with asthma at the Larry Combest Community Health Wellness Center [LCCHWC]. The design for this practice inquiry was descriptive retrospective, using mixed methods for process evaluation of a program through description of nurse practitioner practice at an academic nurse-managed primary care clinic.The nurse practitioners addressed all components of the process of care recommended by the AANP (2007), which includes assessment, diagnosis, development and implementation of a treatment plan, and evaluation of the patient status. However, despite comments about the importance of using evidence based practice in the form of guidelines, results from health records review indicate that nurse practitioners have not fully integrated the NHLBI 2007 asthma guidelines into providing care to adolescents with asthma. This study establishes a baseline measure of adoption of the NHLBI 2007 asthma guidelines by nurse practitioners at this clinic site. The results of this study may ultimately contribute to nurse practitioners' awareness of use of standards of care and improved quality of care for adolescents with asthma.

Primary health care reform is currently underway in Ontario with the goals of improving health care access, quality and continuity of care while increasing patient and provider satisfaction and cost effectiveness. Interprofessional collaboration in the provision of primary health care has been widely espoused in the health care literature as a means of achieving the goals of primary health care reform. Primary health care nurse practitioners in collaboration with physicians and other allied health professionals have a fundamental role in enhancing primary health care in Ontario. The purpose of this study was to explore and describe nurse practitioners’ experiences and perceptions of interprofessional collaboration with physicians in the provision of primary health care in Ontario. A qualitative descriptive study design was used and six nurse practitioners working in a variety of primary health care settings in Ontario were purposively sampled and interviewed regarding their experiences and perceptions of interprofessional collaboration with partnering physicians. Interviews were analyzed using qualitative content analysis techniques and themes were identified. Seven themes were identified as key factors influencing collaboration within the nurse practitioner – physician dyad from the nurse practitioner’s perspective. These themes included: quality of communication, complementary vision, physician remuneration methods, establishing and maintaining relationships, investing time and energy, nurse practitioner competency and expertise and mutual trust and respect. A model of nurse practitioner – physician interprofessional collaboration is used to organize the themes identified. The findings of this study support current recommendations for joint education initiatives for health care professionals and practice initiatives aimed at improving collaboration between partnering nurse practitioners and physicians. Areas for future research include incorporating the client’s experiences and perceptions within collaborative practice as well as developing and evaluating interventions that strengthen collaboration within the health care team / Thesis (Master, Nursing) -- Queen's University, 2009-09-22 12:06:31.203

Thesis (MEd) -- University of South Australia, 1993