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3 emerging primary-care functions for R.N.’s

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Thomas Bodenheimer, M.D., and Laurie Bauer, R.N., write in The New England Journal of Medicine about the expanding role of nurses in the primary-care workforce. Among their observations:

“Clearly, more and more patients will see an NP or a PA {physician assistant} as their primary care practitioner. Physicians will probably focus on diagnostic conundrums and lead teams caring for patients with complex health care needs. A large and growing body of research demonstrates that care delivered by NPs is at least as high quality as that delivered by physicians. In addition, patient-satisfaction scores are similar for NPs and physicians. Moreover, care may cost less when it’s provided by NPs rather than physicians: Medicare beneficiaries assigned to an NP had primary care costs that were 29 percent lower and office-visit and inpatient costs that were 11 to 18 percent lower than those of beneficiaries assigned to a primary-care physician.

“Even with the increased numbers of NP and PA graduates, the ratio of primary care practitioners to population will decline, because only 50 percent of NPs and 32 percent of PAs choose primary-care careers. Thus, other professionals will be needed to care for the growing number of U.S. adults with chronic conditions and geriatric syndromes. Enter the enhanced role of the RN.

While the NP role begins to approximate that of the physician, RNs are assuming three important emerging primary care functions: managing the care of patients with chronic disease by helping them with behavior change and adjusting their medications (e.g., for hypertension and diabetes) according to physician-written protocols; leading complex care management teams to help improve care and reduce the cost of care for patients with multiple diagnoses who are high users of health care services; and coordinating care between the primary-care home and providers of other health care services — in particular, assisting with transitions among hospital, primary care settings, and home.”

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