A study released by researchers at Yale and Pace universities on the way managed care organizations (MCOs) employ nurse practitioners reveals a surprising inconsistency. Even though 82 percent of the MCO executives surveyed said that the use of nurse practitioners as primary care providers should be encouraged, only 44 percent of the health organizations actually listed them that way.
"Most of the respondents seemed to understand the strengths that nurse practitioners bring to the primary care area," note the study's researchers, Sally S. Cohen, R.N., F.A.A.N, assistant professor and director of the Center for Health Policy at the School of Nursing, and Diana Mason, R.N., F.A.A.N, professor at the Lienhard School of Nursing at Pace. In particular, the respondents cited the strengths of good communications skills, emphasis on prevention and use of behavioral approaches. Further, MCO executives reported a high degree of satisfaction with nurse practitioners as primary care providers.
While previous studies suggest that nurse practitioners can safely manage approximately 80 percent of primary-care situations, there are a number of reasons the administrators don't utilize them in accordance with their beliefs. A lack of information among both health care professionals and the public regarding what nurse practitioners are allowed to do is one possible reason, according to the study. (Nurse practitioners have advanced education beyond the level of registered nurses, usually a master's degree. Their practice emphasizes health promotion, disease prevention and management of common problems.)
The study also found that some MCOs, especially those owned or administered by physicians, blocked the listing of nurse practitioners as primary care providers "because of the professional turf issues." Other administrators reported that lack of consumer demand -- which translates to "patient confidence," according to the researchers -- held them back from using nurse practitioners as primary care providers.
To obtain their results, the research team surveyed all licensed MCOs in New York and Connecticut. The results were published in a recent issue of Nursing Economics. Cohen and Mason also studied the experiences of nurse practitioners with managed care in those two states. The findings from that study will be published this spring.
For additional information or to request a reprint of the article, contact Cohen at (203) 737-2545 or send e-mail to sally.cohen@yale.edu.
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