Post‐ACA Trends in the US Primary Care Physician Shortage with Index of Relative Rurality

Gemelas, Jordan

doi:10.1111/jrh.12506

Cited by 16 publications

(14 citation statements)

References 14 publications

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“…Consistent with previous studies, 4 , 6 there was no major change in the degree of medical provider shortages among rural-urban NHs over the study period. Disparities in medical care accessibility due to physician shortage in rural communities have been well-documented, 29 yet no significant difference in physician shortages was observed between rural and urban NHs during the pandemic. Plausibly, increased use of telemedicine visits attenuated the impact of the pandemic on medical provider accessiblity 30 in both rural and urban areas.…”

Section: Discussionmentioning

confidence: 99%

Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status

2021

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The purpose of the study was to examine trends in COVID-19 cases, related deaths, and staffing shortages in nursing homes (NH) by rural and urban status from May 2020 to Feb 2021. Generalized linear mixed models with state-fixed effects were used to estimate the interaction effect of study period and rural/urban status on having at least: one COVID-19 case, one related death, and/or at least one week of staffing shortage using the NH COVID-19 data spanning the 40-week period. The findings revealed shortages in staff, particularly direct care providers, were greatly accelerated in rural NHs as the pandemic wore on over time. Conversely, staffing shortages in urban NHs were relatively stable despite the fluctuating COVID-19 cases over the same time period. The findings highlight the need of identifying effective strategies that prevent rural NHs from encountering staffing deficits in response to long-lasting natural disasters such as the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status

2021

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“…With physicians increasingly leaving rural practice, 24 it is noteworthy that NPs cite practice restrictions as a barrier to rural practice 25 and that recent research indicates NPs are highly likely to relocate to states that allow independent practice 10,26,27 . Considering the costly incentives and investments within the Affordable Care Act targeted toward increasing primary care access in rural areas and their inability to stem primary care shortages, increasing practice authority represents a low cost policy solution to mitigate complications from diabetes in rural counties 22,28 …”

Section: Discussionmentioning

confidence: 99%

“…4,21 Coupling these findings with the lack of association from the number of NPs and primary care physicians per enrollee imply that the problem may not be a shortage of providers but how and where within the county they are deployed-as binary classifications may not adequately capture provider clustering in more urbanized portions of rural counties. 22 Unsurprisingly, practice authority makes no statistical difference in debridements in urban counties where provider supply is presumably sufficient, and plausibly explains the lack of significant results for other measures of provider supply.…”

Section: Discussionmentioning

confidence: 99%

Nurse practitioner scope of practice and the prevention of foot complications in rural diabetes patients

Hughes

Filar

Mitchell

2021

The Journal of Rural Health

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Purpose: Diabetic foot ulcers afflict a quarter of type-2 diabetes mellitus patients and are associated with higher mortality rates among people with diabetes. Routine primary and preventive care is essential to both prevent and treat foot ulcers before they can contribute to further adverse outcomes. One approach for expanding this care to people with diabetes in rural communities is increasing the practice authority of nurse practitioners. This study examines whether the presence of nurse practitioner practice authority is associated with fewer foot ulcer complications in rural populations as measured through the incidence of foot debridement-a common procedure for addressing severe diabetic foot ulcers.Methods: This study uses medical claims to estimate the incidence of foot debridement for US counties. A multivariable linear regression was performed to examine the association between nurse practitioner practice authority and the county incidence of foot debridement after adjusting for measures of local health care workforce and sociodemographics.Findings: Nurse practitioner practice authority was associated with 219.4 fewer foot debridements per 10,000 enrollees (P < .001) in rural counties. Rural health clinics (P < .03) and skilled nursing facilities (P < .03) were also associated with fewer rural debridements. The number of nurse practitioners (P < .69) and primary care physicians (P < .69) per enrollee were not significant. No measure of health care workforce was associated with the incidence of foot debridement in urban counties. Conclusions:Expanding nurse practitioner practice authority may be an effective solution for preventing complications from diabetic foot ulcers in rural communities.

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“…Primary health care has attracted attention in many countries, and a series of measures have been taken to promote access to primary health care, such as India’s rural health centers [ 1 ], Nepal’s primary healthcare (PHC) system [ 2 ], and the Affordable Care Act (ACA) in the United States [ 3 ]. In China, primary health care is undertaken by primary medical and health care institutions (PMHCIs), primarily community health service centers and township hospitals, which provide general clinical care and basic public health services to residents [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

A New Perspective for Improving the Human Resource Development of Primary Medical and Health Care Institutions: A Structural Equation Model Study

Jia

Cao

et al. 2021

IJERPH

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In some countries, including China, primary health care is rarely utilized because of medical personnel shortages at primary medical and health care institutions (PMHCIs). Several studies suggest that the most effective solution is to guide qualified doctors and medical graduates to work in PMHCIs, but the studies and measures have been formulated only from the perspective of the government and PMHCIs; few have considered the subjective willingness of medical personnel. Therefore, it is necessary to explore the measures to develop human resources of PMHCIs from the guiding object. This research was divided into two parts based on implicit theory and a lexical approach. The first part collected the factors affecting their choosing PMHCIs for employment, and the second part used exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling (SEM) to explore the dimensions and paths of the influencing factors. At last, seven factors were obtained from the EFA, and the SEM hypothesis fit the data well. Internal Organization Development, Patient Factor, Remuneration and Development, and Family Support had a significantly positive effect on the Sense of Gain of medical personnel seeking employment at PMHCIs, whereas both Job Responsibilities and Condition of the City Where the PMHCI Is Located had no significant effect. In addition, the indirect effects of Internal Organization Development and Condition of the City Where the PMHCI Is Located on the Sense of Gain were significant. The Patient Factor, Family Support, and Remuneration and Development significantly mediated the relationship between the internal and external environment of the institution and the Sense of Gain, whereas the mediating effect of Job Responsibilities was not significant. The improvement of family support, remuneration and development, and patient factors increase the willingness of medical personnel to seek employment at PMHCIs. In addition, the internal and external environments of a PMHCI play a vital role in guiding medical personnel to PMHCIs for employment. This research provides theoretical support for improving the development of human resources, guiding medical personnel to work in PMHCIs, and promoting the use of primary care services.

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Post‐ACA Trends in the US Primary Care Physician Shortage with Index of Relative Rurality

Cited by 16 publications

References 14 publications

Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status

Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status

Nurse practitioner scope of practice and the prevention of foot complications in rural diabetes patients

A New Perspective for Improving the Human Resource Development of Primary Medical and Health Care Institutions: A Structural Equation Model Study

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