February was American Heart Month. How are Arkansas' hearts doing? According to the Centers for Disease Control and Prevention, we're losing too many Arkansans too early because of preventable heart disease.
Heart disease is a threat not only to older adults, but increasingly younger adults are also at high risk. The American Heart Association reports that, every year, one in four deaths is caused by heart disease. In the CDC report "Potentially Preventable Deaths Among the Five Leading Causes of Death--United States, 2010 and 2014," researchers reported that in 2014, almost half of the 4,258 Arkansans who died of heart disease could have been saved--2,260 friends and family members, teachers, truck drivers, and Hogs fans.
Residents in rural areas are even more likely to die from preventable causes than those in urban areas, according to the 2019 CDC report "Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties--United States, 2010--2017."
Why is this happening? One explanation is that we have a serious shortage of primary-care providers, and primary-care shortages disproportionately affect people in poor and rural areas as well as racial and ethnic minorities. That makes getting access to health services more expensive and difficult than it has to be.
According to "State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025," published by the U.S. Health Resources and Service Administration in 2016, Arkansans face a growing shortage of primary-care physicians. Arkansans may need as many as 590 primary-care physicians in the next five years.
What can we do? Increase access to quality health services, health information, and preventive care. Access to primary care reduces health inequalities and health-care costs by decreasing the need for expensive and unnecessary specialized care.
One way to do this is to let Arkansas nurse practitioners (NPs) practice to the full extent of their education and training. The National Academy of Medicine (2010), National Governors Association (2012), and Federal Trade Commission (2014) all support this proposal. All of these organizations have careful studies pointing toward the clear benefits of removing costly restrictions. This is not a radical idea. In 2017, 22 other states and the District of Columbia allowed NPs full practice authority, which includes the ability to legally provide primary-care services.
Nurse practitioners are registered nurses with either a master's or a doctorate in nursing who practice in ambulatory, acute, or long-term care as primary and/or specialty providers. Right now, they are hamstrung by rules requiring them to work under a supervising physician. Our state regulations require NPs to be in a complicated and expensive collaborative agreement with a physician before they can provide services they are educated and trained to provide.
Evidence presented by the Institute of Medicine (2010) shows that NPs are capable of providing high-quality safe patient care. There is no evidence that the outcomes of the services provided by NPs are inferior to those provided by physicians. State legislators should be welcoming their work instead of outlawing it. Arkansans deserve more follow-up meetings with providers and better access to clinical preventive services, such as blood pressure management and cancer screenings, which can be provided by letting our NPs practice to their fullest capacity and potential.
According to the study "Improving Heart Failure Readmission Costs and Outcomes with a Hospital-to-Home Readmission Intervention Program" by Kenneth Bilchick and others published in the American Journal of Medical Quality in 2018, heart-failure patients who received follow-up care from NPs within 30 days after hospital discharge experienced a 41 percent lower mortality rate and a 24 percent reduction in the number of readmitted days to the hospital. These NP patients were sicker than those that did not receive follow-up care from NPs.
There have already been some attempts by state legislators to remove this restriction. During the 2019 legislative session, members of the Senate Public Health, Welfare, and Labor Committee considered Senate Bill 189 sponsored by Sen. Dave Wallace, and members of the House Public Health, Welfare and Labor Committee considered House Bill 1282 sponsored by Rep. Robin Lundstrum which attempted to remove the requirement for a mandatory collaborative practice agreement for NPs.
Unfortunately, both bills failed in committee.
By allowing NPs their full practice authority to prescribe and treat to the full extent of their education and training, and removing costly restrictions that are not proven to increase the quality of care, Arkansans can have healthier hearts and happier lives.
Dr. Maryam Almasifard is an economic policy analyst at the Arkansas Center for Research in Economics (ACRE) at the University of Central Arkansas in Conway. The views expressed are those of the author and do not necessarily reflect those of the University of Central Arkansas.
Editorial on 03/09/2020