Delivery of High Quality Primary Care in Community Health Centers: The Role of Nurse Practitioners and State Scope of Practice Restrictions

In response to the increased demand for primary care in the United States—a byproduct of a growing elderly population and insurance expansion under the Affordable Care Act (ACA)—the total number and capacities of community health centers (HCs) is expected to grow. While HCs have historically depended on physicians to deliver the majority of their care, more and more, they are shifting to non-physician clinicians, especially nurse practitioners (NPs); yet, little is known about the quality of care delivered by NPs in HCs or about the role state occupational restrictions have on these practitioners or their patients. Using quasi-experimental methods and data from the community health center subsample of the National Ambulatory Medical Care Survey (NAMCS), this dissertation explores three distinct, but related, research questions regarding NP-delivered care in HCs—its effectiveness and comparability to physician care, the extent that tradeoffs in the quantity and quality of care are made, and the real-world risks and benefits of states easing their scope of practice restrictions. Findings, which suggest that NP care is comparable to physician care in most ways and that the quality of NP-delivered care does not significantly vary irrespective of states’ NP independence status, have important implications for policy and practice

Ten Years After Keeping Patients Safe: Have Nurses\u27 Work Environments Been Transformed?

Issue 22 of the Charting Nursing\u27s Future series examines progress made in the 10 years since the Institute of Medicine issued Keeping Patients Safe: Transforming the Work Environment of Nurses

Is Adversity in Childhood Linked to Marijuana Use in Adulthood?: Findings from the Behavioral Risk Factor Surveillance System

Adverse childhood experiences (ACEs) are potentially traumatic events, which can have long-term, negative consequences. Few studies have examined ACEs\u27 relationship to marijuana use. We examined the association between ACEs and past-month marijuana use among adults and the pathways between childhood adversity and marijuana use. Adults from five states (n = 22,991) who responded to the 2019 Behavioral Risk Factors Surveillance System were included. We examined the prevalence of ACEs and marijuana use. We employed generalized structural equation modeling to assess the relationship between ACEs and marijuana use and the role of depression and poor mental and physical health as possible mediators. Overall, 65.0% of the population reported 1+ ACE. Heavy marijuana use and past-month marijuana use prevalence rates were 10.3% and 5.0%, respectively. We found mediation effects for depression and poor mental health but not poor physical health. The number of ACEs was associated with a statistically significant increase in any past-month marijuana use-indirect effects ranged from 1.0 (95% CI, 1.0-1.0) to 1.4 (95% CI, 1.2-1.7), direct effects ranged from 1.1 (95% CI, 07-1.7) to 5.3 (95% CI 3.2-8.8), and total effects ranged from 1.1 (95% CI, 0.7-1.7) to 5.9 (95% CI, 3.6-9.8). Women, married persons, and middle aged and older adults had a lower odds of marijuana use. Reporting at least one HIV risk behavior was associated with an increased odds of marijuana use. ACE exposure was positively associated with marijuana use. Depression and poor mental health separately mediated this relationship

Are Patients Who Trust Their Providers More Likely to Use Medical Cannabis?

Trust is an essential element of the patient-provider relationship and has been associated with better patient outcomes; however, it is not clear what role trust might play in influencing patients\u27 willingness to try medical cannabis when it is recommended in states where it has been legalized for medical use. To explore the relationship between peoples\u27 trust in their health care clinicians and hospitals and their willingness to consider using medical cannabis if it is recommended by their clinician or hospital. We conducted an anonymous, cross-sectional, online survey of adults who participated in the Qualtrics Research Company Panel and used quotas to match our sample to the characteristics of the U.S. population. We received 1120 completed surveys. The vast majority of respondents (84.4%) reported having a regular provider and 42.5% of those who reported having a regular physician and nearly 35.6% of those who reported having another regular provider (e.g., nurse practitioner, physician assistant) reported that they completely trusted that clinician. Those who reported completely trusting their usual clinician were more than twice as likely to report they would definitely use medical cannabis if recommended (42.5% vs 20.6%). Similarly, the greater respondents\u27 trust in hospitals, the more likely they were to report a willingness to consider using recommended medical cannabis. Patient trust in their health providers is related to patients\u27 willingness to use recommended medical cannabis

sj-docx-1-ppn-10.1177_15271544231168607 - Supplemental material for How Are Patients Who Legally Use Medical Marijuana Treated When Hospitalized?

Supplemental material, sj-docx-1-ppn-10.1177_15271544231168607 for How Are Patients Who Legally Use Medical Marijuana Treated When Hospitalized? by Ellen T. Kurtzman and Jessica Greene in Policy, Politics, & Nursing Practice</p

Why do Americans use marijuana?

BACKGROUND: Marijuana is the most commonly used illicit drug in the United States; yet, little is known about why adults use it. We examined the prevalence of past-month marijuana use by users’ reasons for use—medical, recreational, and both—and identified correlates of each group. METHODS: Data from 20 states, which participated in the 2017-2019 Behavioral Risk Factor Surveillance System and fielded the marijuana use module, and multinomial logistic regression analysis were used to identify risk factors for past-month marijuana use by reason for use. User profiles were developed to illustrate how states’ policy environments influenced reported reasons for use. RESULTS: The average predicted probabilities of past-month marijuana use for medical, recreational, and both reasons were 28.6%, 38.2%, and 33.1%, respectively. Age, gender, marital and employment status, income, mode and frequency of administration, and health status were associated with reasons for use. The reasons that young adult males who were infrequent marijuana users and binge drinkers gave for their marijuana use varied by state policy environment—in legal states, the average predicted probabilities were 5.3% lower for recreational reasons and 5.0% higher for both reasons. Reported reasons for past-month marijuana use did not significantly differ by state policy environment among daily users who were older women in poor mental and physical health. DISCUSSION: Significant differences existed in the characteristics of past-month marijuana users by reasons for use. Our estimates can serve as a baseline against which post-legalization marijuana users’ reasons for use can be compared as state policy environments shift