Primary care nurse practitioner work environments and emergency department utilization among older adults with substance use disorders in rural areas.

Autor: Turi E; University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104, United States of America. Electronic address: eleanor.turi@pennmedicine.upenn.edu., McMenamin AL; Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America., Martsolf G; University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15213, United States of America., Hasin D; Columbia University Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States of America; Columbia University Mailman School of Public Health; 722 West 168th Street, New York, NY 10032, United States of America., Han BH; University of California San Diego Department of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, United States of America., Liu J; Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America., Poghosyan L; Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America; Columbia University Mailman School of Public Health; 722 West 168th Street, New York, NY 10032, United States of America.
Jazyk: angličtina
Zdroj: Journal of substance use and addiction treatment [J Subst Use Addict Treat] 2024 Feb; Vol. 157, pp. 209285. Date of Electronic Publication: 2023 Dec 28.
DOI: 10.1016/j.josat.2023.209285
Abstrakt: Introduction: The prevalence of substance use disorders (SUDs) is growing among older adults, and older adults in rural areas face disparities in access to SUD care. Rural older adults with SUDs commonly have comorbid chronic conditions that puts them at risk for frequent acute healthcare utilization. In rural areas, primary care for patients with SUDs are increasingly provided by nurse practitioners (NPs), and quality primary care services may decrease ED visits in this population. Yet, NP-delivered primary care for rural older adults with SUDs may be limited by work environment barriers, which include lack of support, autonomy, and visibility. This study assessed the relationship between the NP work environment and ED utilization among rural older adults with SUDs.
Methods: This was a secondary analysis of cross-sectional data from a large survey of NPs in six U.S. states merged with Medicare claims. The study measured the NP work environment by the four subscales of the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), which measure 1) independent practice and support, 2) NP-physician relations, 3) NP-administration, and 4) professional visibility. Multilevel logistic regression models, adjusted for practice and patient covariates, assess the relationship between the NP work environment and all-cause ED use.
Results: The sample included 1152 older adults with SUDs who received care at 126 rural NP primary care practices. NP independent practice and support at the practice was associated with 49 % lower odds of all-cause ED visits among older adults with SUDs. There were no relationships between the other NP-PCOCQ subscales and all-cause ED visits.
Conclusions: Organizational support for NP independent practice is associated with lower odds of all-cause ED utilization among rural older adults with SUDs. Practice administrators should ensure that NPs have access to support and resources to enhance their ability to care for rural older adults with SUDs. Ultimately, these practice changes could reduce ED utilization and health disparities in this population.
Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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