Primary Care Shortage Response

Running head: SOLUTION TO THE PRIMARY CARE SHORTAGE Solution to the Primary Care Shortage Ana Trana Grand Canyon University 10/13/2019 1 SOLUTION TO THE PRIMARY CARE SHORTAGE 1 The solution to the Primary Care Shortage Primary care has been a challenge in recent years due to many arising factors such as high population and the shortage of nursing practitioners. Millions of Americans have been denied sufficient access to primary care. This issue has put patients at high risk due to lack of quality treatment provided in health facilities across the nation. It has been a developing problem in recent years due to the rising population. There are numerous solutions regarding the primary care shortage across the nation that can be developed and implemented to reduce its impact (Brown, 2018). The Setting in which the Primary Care Shortage can be Observed This issue can be observed through developing research and theoretically analyzing the issue in several health facilities in at least ten states across the US. Through an observational research design, an analysis can be generated from the health facilities to the affected communities. Experimental research can also be useful in this case to ascertain the impact of this issue on the American people. Furtherly, this issue can be observed by substantiating the available nursing practitioners in public healthcare facilities against the number of patients admitted. Through this, it will avail the problem and its impact. A Detailed Description on the Primary Care Shortage Issue and its Solution Conferring to Edmunds (2014), the number of Primary Care Physicians (PCP) and NPs needed in the healthcare sector is going to rise by the year 2025 due to two significant reasons. The first significant issue is the limited scope-of-practice that NPs have been offered by most of the states in the US. This policy has limited NPs to provide primary care while they have the required skills (Pentecost, 2017). Secondly, the rising population in the US has been way too high, thus requiring an increase of nurses in the healthcare sector which hasn’t been implemented. Primary care shortage is an issue that needs a quick solution to enhance SOLUTION TO THE PRIMARY CARE SHORTAGE 2 quality care and to reduce the mortality rate in the US (Hackey et al., 2018). This issue has resulted in a loss of control to both acute and chronic diseases. Therefore, solutions must be provided to better the healthcare services and the primary care across the nation The Impact of the Primary Care Shortage Primary care shortage has various and adverse impacts in the healthcare sector. The primary effect is risking the lives of millions of patients due to lack of quality healthcare. According to Buckley et al. (2013), primary care shortage has led to an inexorable rise of chronic and acute diseases that should be manageable in the 21st century. These are the two major impacts of this issue, affecting the American people adversely. Significance of the Primary Care Shortage and its Implication in Nursing The principal importance of this issue is that it has enabled the healthcare sector to be aware of the gaps they face. Shortcomings such as the limitation of the scope-of-practice on NPs while they are supposed to be providing services to patients. This issue in nursing implied the propelled ACA policy and generated a better healthcare system across the US. Quality healthcare has also been prioritized with millions of patients receiving insurance coverage (Collins, 2012). Primary Care Shortage Response

A Proposed Solution to the Primary Care Shortage The best recommendation to the primary care shortage is changing the policies of the scope-of-practice on NPs across the US (Glass et al. 2017). This move will enable the NPs to provide primary care services to patients, thus enhancing quality care. Also, physicians should work along with NPs to build a workforce that will address the primary care shortage (Fodeman, 2015). These two sanctions will ensure that patients receive adequate and timely healthcare services, thus reducing the repercussions of this issue. SOLUTION TO THE PRIMARY CARE SHORTAGE References Brown, T., (2018). Nurse Practitioners: A Commonsense Solution to the Primary Care Shortage. Journal of Nursing. Buckley, L., et al. (2013). An Analysis of the Primary Care Physician Shortage and the Effects of the Affordable Care Act. Nursing Journal. Collins, S., (2012). Primary Care Shortages: Strengthening This Sector Is Urgently Needed, Now and in Preparation for Healthcare Reform. NCBI Nursing Journal Edmunds, M., (2014). Important NP Issues, Volume 10. Journal of Nursing Practitioner. Retrieved From: https://doi.org/10.1016/j.nurpra.2014.09.007 Fodeman, J., (2015). Solutions to the Primary Care Physician Shortage, Vol 128. American Journal of Medicine. Glass, D., et al. (2017). The Impact of Improving Access to Primary Care. NCBI Journal of Evaluation in Clinical Practice. Hackey, R., et al. (2018). Rethinking the Shortage of Primary Care Physicians, Vol 31. Journal of the American Academy of PAs. Pentecost, M., (2017). Looming Physician Shortage? Vol 14. Journal of the American College of Radiology. 3 Literature Evaluation Table Student Name: Ans Trana Criteria Article 1 Author, Journal (PeerReviewed), and Permalink or Working Link to Access Article Article Title and Year Published Poghosyan, L., & Aiken, L. The Journal of ambulatory care management Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/25748259 Maximizing nurse practitioners’ contributions to primary care through organizational changes (2015). Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The purpose of the study was to explore the roles and characteristics for nurse practitioner needed to ensure quality delivery of services in care settings. Design (Type of Quantitative, or Type of Qualitative) The study was a cross-sectional survey Setting/Sample The study involved 592 nursing practitioners within primary care setting The participants reported on job satisfaction, intention to leave, support available and relations with management. Methods: Intervention/Instruments Analysis Data was analyzed through thematic analysis technique. Topics and patterns in the data was identified and explored. The participants reported deficits in organizational context of care, poor working relationships and problematic resources deployment. Key Findings Recommendations Explanation of How the Article Supports EBP/Capstone Project Organizational structure should be reformed to redefine roles and function of nursing practitioners. The article talks about deficit of nurse practitioner and explains how poor organizational structures contribute to this problem. © 2015. Grand Canyon University. All Rights Reserved. Criteria Article 2 Author, Journal (PeerReviewed), and Permalink or Working Link to Access Article Article Title and Year Published Wojnar, D. M., & Whelan. Nursing Outlook Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/28034448 Preparing nursing students for enhanced roles in primary care: The current state of pre-licensure and RN-to-BSN education (2017). Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The aim of this study was to explore the state of prelicensure and bachelor education on the implementation of primary care content. Design (Type of Quantitative, or Type of Qualitative) The study was a qualitative design that used online surveys Setting/Sample The sample consisted of 529 schools in USA. Methods: Intervention/Instruments Online surveys Analysis Emerging patterns in the data were analyzed using summative content analysis Some of the participants had implemented primary care content but others found it difficult to implement. Key Findings Recommendations Explanation of How the Article Supports EBP/Capstone Project Criteria Nursing managers and scholars must work together with clinicians to design and improve clinical experience. The article brings to light problems in current healthcare and how transformation is needed to ensure quality care. Article 3 Author, Journal (PeerReviewed), and Brisen, H., Dunn, A., Parada, A., & Renden. Academic Medicine, 91(2), 224-228. © 2017. Grand Canyon University. All Rights Reserved. Permalink or Working Link to Access Article Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26397700 Article Title and Year Published Addressing the primary care shortage on a shoestring: a successful track in an internal medicine residency (2016). Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The study addresses the problem of primary care shortage Design (Type of Quantitative, or Type of Qualitative) Qualitative experimental study Setting/Sample University of New Mexico Methods: Intervention/Instruments A resident driven primary care track was created to designate blocks of time dedicated to primary care training. Analysis Outcomes were analyzed by evaluating the effectiveness of the program There was a considerable increase in the number of residents pursuing primary care training. Creation of more primary care track with administrative support The study is important because it address the problem being investigated by the capstone project. Primary Care Shortage Response

Key Findings Recommendations Explanation of How the Article Supports EBP/Capstone Project Criteria Article 4 Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Xu et al. Nursing outlook, 66(3), 263-272. Retrieved from: https://www.sciencedirect.com/science/article/abs/pii/S00296 5541730605X Article Title and Year Published Federally qualified health centers reduce the primary care provider gap in health professional shortage counties (2018). Research Questions (Qualitative)/Hypoth The study examined trends in primary care supply and the success of FGHC in reducing the gap in provider shortage © 2017. Grand Canyon University. All Rights Reserved. esis (Quantitative), and Purposes/Aim of Study Design (Type of Quantitative, or Type of Qualitative) The study was a retrospective cohort study Setting/Sample The cohort study used data sample from national county level from 2009 to 2013. Methods: Intervention/Instru ments The sample included primary care providers like physicians, nurses and assistants. Analysis Thematic analysis was used to bring out major trends and patterns in the data Partial Health professional shortage areas (HPSA) showed the highest levels of care provider supply followed by non-HPSA. Key Findings Recommendations More federally qualified health centers (FQHC) should be developed to address shortage of care providers. Explanation of How the Article Supports EBP/Capstone Project The study answers some of the major questions being sought by the capstone project Criteria Article 5 Author, Journal (PeerReviewed), and Permalink or Working Link to Access Article Song, H., Ryan, M., Tendulkar, S., Fisher, J., Martin, J., Peters, A. S & Singer, S. J… Health care management review. Link: https://journals.lww.com/hcmrjournal/fulltext/2017/01000/Team_dynamic s,_clinical_work_satisfaction,_and.4.aspx Article Title and Year Published Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: a mixed methods study (2017) Research Questions The purpose of the study was to examine the relationship among team dynamics, work satisfaction and coordination of care © 2017. Grand Canyon University. All Rights Reserved. (Qualitative)/Hy pothesis (Quantitative), and Purposes/Aim of Study Design (Type of Quantitative, or Type of Qualitative) Setting/Sample The study was a mixed methods cross-sectional survey The surveys were administered to 548 participants working in healthcare settings. Methods: Intervention/Ins The cross sectional surveys were administered to 548 PCPS and 65 percent truments responded. The researchers assessed the relationship of tem dynamics with satisfaction ad perception of care. Analysis The researchers used qualitative evaluation with quantitative evaluation Key Findings Team dynamics was positively related with clinical work satisfaction and care quality. Coordination mediated the relationship between team dynamics and satisfaction. There was no mediating effect for physician residents Recommendatio Improving team dynamics can greatly improve satisfaction and quality of ns care Explanation of How the Article Supports EBP/Capstone Project The article brings to light problems in current healthcare and how different factors contribute to work satisfaction Criteria Article 6 Author, Journal (PeerReviewed), and Permalink or Working Link to Access Article Nkhata, Muzambi, M., Ford, D., Chan, A. K., Abongomera, G., Namata & Mabugu health services research Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/27852291 © 2017. Grand Canyon University. All Rights Reserved. Article Title and Year Published Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study Design (Type of Quantitative, or Type of Qualitative) Shifting human resources for health in the context of ART provision: qualitative and quantitative findings from the Lablite baseline study. (2016). The purpose of the study was to describe and compare national and intercountry delivery of ART services The study was a cross sectional baseline survey Setting/Sample The study involved a sample of 81 health facilities in Malawi, Uganda and Zimbabwe. Methods: Intervention/Instruments The study was done between 2011 and 2012. Primary Care Shortage Response

Data was collected using questionnaires on facility characteristics, human resources and service provision. Analysis Data was analyzed by looking at interesting patterns using content analysis In Malawi and Uganda, primary care facilities were run by non-physicians while in Zimbabwe, they were run by nurses and midwives. Turnover was high in both countries. Key Findings The introduction of ART increased workload. Low job satisfaction was linked to low salaries, lack of training and extended working schedules. Recommendations Explanation of How the Article Supports EBP/Capstone Project More resources are need for task shifting. Innovative methods to improve care and training are also needed. The study is relevant because it exposes the problem of high turnover in healthcare settings and how organizational structure contributes to this problem Criteria Article 7 Author, Journal (PeerReviewed), and Permalink or Working Link to Access Article Chimwaza, W., Chipeta, E., Ngwira, A., Kamwendo, F., Taulo, F., Bradley, S., & McAuliffe Human resources for health, 12(1), 17. Link: https://human-resourceshealth.biomedcentral.com/articles/10.1186/14784491-12-17 © 2017. Grand Canyon University. All Rights Reserved. Article Title and Year Published What makes staff consider leaving the health service in Malawi? Human resources for health (2014). Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The aim of the study was to investigate factors that contribute to high turnover in Malawi healthcare Design (Type of Quantitative, or Type of Qualitative) The study was a descriptive qualitative study Setting/Sample 84 participants were involved in the study and data was collected using Critical Incident Analysis tool. Methods: Intervention/Instruments Data was collected using critical incident analysis interview Analysis Thematic analysis was used to explore reasons for leaving job 69 percent of the participants said they experienced demotivating incidents that made them want to leave job. Some of the most common reasons for leaving the job were unfair treatment, disrespect, lack of recognition and delays in payment. Key Findings Recommendations Explanation of How the Article Supports EBP/Capstone Project The management should create and enabling environment and consider rewarding employees. The study provides some of the reason that contribute to high turnover in healthcare settings References Poghosyan, L., & Aiken, L. H. (2015). Maximizing nurse practitioners’ contributions to primary care through organizational changes. The Journal of ambulatory care management, 38(2), 109-117. © 2017. Grand Canyon University. All Rights Reserved. Wojnar, D. M., & Whelan, E. M. (2017). Preparing nursing students for enhanced roles in primary care: The current state of pre-licensure and RN-to-BSN education. Nursing outlook, 65(2), 222-232. Brislen, H., Dunn, A., Parada, A., & Rendon, P. (2016). Addressing the primary care shortage on a shoestring: a successful track in an internal medicine residency. Academic Medicine, 91(2), 224-228. Xue, Y., Greener, E., Kannan, V., Smith, J. A., Brewer, C., & Spetz, J. (2018). Federally qualified health centers reduce the primary care provider gap in health professional shortage counties. Nursing outlook, 66(3), 263-272. Song, H., Ryan, M., Tendulkar, S., Fisher, J., Martin, J., Peters, A. S & Singer, S. J. (2017). Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: a mixed methods study. Health care management review, 42(1), 28-41. Nkhata, M. J., Muzambi, M., Ford, D., Chan, A. K., Abongomera, G., Namata, H & Mabugu, T. (2016). Shifting human resources for health in the context of ART provision: qualitative and quantitative findings from the Lablite baseline study. BMC health services research, 16(1), 660. Chimwaza, W., Chipeta, E., Ngwira, A., Kamwendo, F., Taulo, F., Bradley, S., & McAuliffe, E. (2014). What makes staff consider leaving the health service in Malawi?. Human resources for health, 12(1), 17. Kinfu, Y., Dal Piz, M. R., Mercer, H., & Evans, D. B. (2009). The health worker shortage in Africa: are enough physicians and nurses being trained? © 2017. Grand Canyon University. All Rights Reserved. …