Introduction
Access to quality primary care is challenging for rural populations and individuals
residing in primary care health professional shortage areas (HPSAs). The ability of
nurse practitioners (NPs) to provide full care is governed by state scope-of-practice
(SOP) regulation, which is classified into three types: full SOP, reduced SOP, and
restricted SOP. Understanding how legislative and regulatory decisions can influence
supply of NPs in underserved areas can help guide effective health policies to reduce
disparities in access to care.
Objective
To investigate the trends in NP supply in rural and primary care HPSA counties and
their relationship with SOP regulation.
Methods
The authors conducted longitudinal data analyses using an integrated county-level
national data set from 2009 to 2013. A hierarchical mixed-effects model was performed
to assess the relationship between state SOP regulation and NP supply in rural and
primary care HPSA counties.
Results
The number of NPs per 100,000 population increased in rural and primary care HPSA
counties across states with various types of SOP regulation between 2009 and 2013.
Compared with the NP supply in rural or primary care HPSA counties in states with
reduced or restricted SOP regulation, NP supply in those counties in states with full
SOP regulation was statistically significantly higher.
Conclusions
State full SOP regulation was associated with higher NP supply in rural and primary
care HPSA counties. Regulation plays a role in maximizing capacity of the NP workforce
in these underserved areas, which are most in need for improvement in access to care.
This information may help inform state regulatory policies on NP supply, especially
in underserved areas.
Keywords
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