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EXECUTIVE SUMMARY
* A systematic review of the methodologies was employed in six published cost analyses of increasing scope of practice for advanced practice registered nurses (APRNs).
* Despite differences in how the costs analyses were calculated, all six studies suggest expanding APRNs' scope of practice could decrease healthcare costs, especially for the state as pertinent stakeholder.
* However, these studies did not examine cost savings for the patient.
* There is a need for future studies to employ more rigorous methodology and focus on the cost benefits to patients.
he U.S. Health Resources and Services Administration (HRSA, 2013) reported a nationwide shortage of primary care physicians (PCPs). HRSA projected the PCP shortage to be 20,400 by 2020. Advanced practice registered nurses (APRNs) may be utilized to address the dire PCP shortage. APRNs are trained to perform about 90% of the medical care traditionally performed by PCPs (Bauer, 2010). Many state laws restrict the scope of practice (SOP) of APRNs, thus preventing APRNs from performing necessary care, such as prescribing controlled substances. Additionally, state law may require these services be performed under supervision of a PCP and disallow direct billing by APRNs.
Availability and Quality of Care
Drummond, Stoddart, and Torrance (1997) recommended a healthcare alternative be examined for its availability, efficacy, and effectiveness before cost analysis. With over 125,000 APRNs in the United States (American College of Physicians, 2009), APRNs appear to be an available resource to address the PCP shortage. Most recently, in reaction to highly public criticism for poor access to care, the U.S. Department of Veterans Affairs (VA, 2016) proposed expanding SOP of its APRNs to "increase veterans' access. This access allows the VA to expand the pool of qualified healthcare professionals who are authorized to provide primary health care..." and thus "increase VA's capacity to provide timely, efficient, and effective primary care services" (p. 33155). The VA joins several states that have expanded SOP to provide care, especially to rural and medically underserved communities. In short, APRNs are available to provide care.
Efficacy and effectiveness involved providing the same or better quality of care for patients. Newhouse and co-authors (2011) completed a systematic review of outcome studies addressing the quality of care provided by APRNs. Compared to physicians, APRNs...