Nurse Practitioners and the Allocation of Resources

In my last post, I made a rather conclusory (and parenthetical) statement regarding the utilization of nurse practitioners in retail health clinics. I wrote:

Retail health clinics have sprouted up across America as of late. They can be found in grocery stores and pharmacies, are open nights and weekends, often (wisely) utilize the services of nurse practitioners for minor ailments and feature a clearly listed schedule of fees.

Today I’ll clarify. The view espoused is largely based upon simple resource allocation theory: that one utilizes resources effectively by matching the need with the skill; that to underutilize is to engage in waste, and, given demand and a shortage of doctors, when a physician is attending to minor ailments, and charging physician rates to do so, society has experienced a net loss.

The trick of course is in a) making sure that there is a sufficient supply of well trained nurses (you may wish to take a look at this interesting RWJF blog from Susan Hasmiller, “projected shortage of 500,000 nurses by 2020,” despite the present difficulty of some nurses to find work ); and b) assuring that the need of the client is matched with the appropriate level of skill: that the service provider is capable.

According to the Mayo Clinic, “NPs are registered nurses (RNs) who are prepared, through advanced education and clinical training, to provide preventive and acute health-care services to individuals of all ages. Today, most NPs complete graduate-level education that leads to a master’s degree. They work independently and collaboratively on the health-care team.”

As to the capability of nurse practitioners, this quote (n. 14) from William M. Sage, Out of the Box: The Future of Retail Medical Clinics, Harvard Law And Policy Review Online (2009), is worth noting:

Debate over the relative merits of primary care from nurse practitioners and from physicians is purely rhetorical. A review of 11 trials and 23 observational studies in primary care settings concluded that “[q]uality of care was in some ways better for nurse practitioner consultations.” Sue Horrocks et al., Systematic Review of Whether Nurse Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors, 324 BRIT. MED. J. 819, 819 (2002). See also Linda H. Aiken, Achieving an Interdisciplinary Workforce in Health Care, 348 NEW ENG. J. MED. 164 (2003) (editorial describing the quality of non-physician professionals); Mary O. Mundiger et al., Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial, 283 JAMA 59 (2000) (demonstrating equivalent outcomes).

Robert Wood Johnson Foundation Looks to Help “Navigate” Health Care Reform

photo by aulia.m via flickr

As we posted back in January, “California Foundations Advocate for Health Care Reform,” the L.A. Times had reported that Paul Brest, “president of the William and Flora Hewlett Foundation in Menlo Park and author of a book on philanthropic strategies” stated that: “What I’ve seen is foundations moving from thinking all we needed to do is support good research in the field and the rest will happen to realizing that unless we are going to support organizations to take the research and try to turn it into policy, then the research is going to sit in the bottom of a pile somewhere.” With a noted caveat (”Advocacy is risky for foundations, since most are categorized by the IRS as 501(c) nonprofits, which restricts them from direct lobbying or participation in partisan politics.”), one welcomes the foundations and their massive intellectual and financial capital further into the fray. They hold the talent and ability of some of the best and brightest among us.

Having said that, the Robert Wood Johnson Foundation (RWJF) has advanced the battle line one smart step forward. Whereas the lobbying spoken of above goes to delivery of the “message,” RWJF has undertaken to put the message in a more deliverable form.

There’s an interesting post on the subject over at the RWJF Health Reform Blog, The Users’ Guide to the Health Reform Galaxy. The post was written by Brian Quinn, Ph.D, a program officer in the RWJF Research and Evaluation Unit, and goes to the question of form regarding applied research, or “How to package the evidence for health reform.”

Mr. Quinn smartly points out that considering the abundance and complexity of journal articles and reports intent on health reform that each day brings, without some form of translation and synthesis geared to those who will actually make decisions about health reform, the “applied” portion of “applied research” may turn out to be nothing more than just an intent.

As a means of cultivating application, and assuring that worthwhile research doesn’t languish “at the bottom of the pile,” RWJF has initiated the Synthesis Project, “to produce user-friendly briefs and reports that synthesize research findings on perennial health policy questions.” The Project is timely and their work is well worth a look.

At the end of a post the other day, I noted some personal experience relating to the sensibility of providing cancer patients with “Navigators” to help them best understand and utilize the health care resources at hand. I finished the post by stating: “It is simply not reasonable to think that patients will do (or do well) that which they do not understand.” Substitute “policy makers” for “patients” and the statement still holds true.