Practitioner Perspectives: How Nurse-Led Primary Care Can Improve Outcomes

Primary care is a critical link in providing the right care at the right time. Yet, there is an overwhelming shortage of primary care physicians.

Data from the Primary Care Collaborative found the U.S. can expect a primary care physician shortage of anywhere from 21,400 to 55,200 by 2033. Nurse practitioners (NPs) have and will continue to fill in physician access gaps. Patients who saw an NP showed similar levels of physical, emotional, and social function to those who saw physicians after one year of receiving care, according to a clinical trial published in the Annals of Internal Medicine.

Research has found that patients under the care of NPs have fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations, higher patient satisfaction, and fewer unnecessary emergency room visits than patients under the care of physicians.

Currently, there are more than 325,000 nurse practitioners performing more than a billion patient visits annually. However, there are several barriers that prevent practices from fully utilizing NP care.

Over half the states in the U.S. have still not granted full practice authority for nurse practitioners. The American Association of Nurse Practitioners advises states to “restrict or reduce NPs’ ability to practice by limiting licensure authority are more closely associated with geographic health care disparities, higher chronic disease burden, primary care shortages, higher costs of care and lower standing on national health rankings."

Granting full practice authority could help to reduce the bureaucracy and subsequent bottlenecking to get more NPs out to high need areas, helping to fill those gaps, and allow greater access to care.  

With attention on reducing costs, the focus is typically the immediate need for transparency in pricing, reducing waste, and limiting unnecessary treatments. However, the larger picture is easy access and frequent touch points with quality primary care are being shown to reduce the prevalence and severity of chronic diseases, such as hypertension. Yet, primary care spending across commercial payers was shown to actually decrease over time, from just 4.67 percent in 2019 from 4.88 percent of national healthcare spending in 2017.

More than 75 percent of healthcare costs are due to chronic conditions, and 50 percent of all Americans have a chronic condition. These numbers are just one small example of the focus in the U.S. on intervention rather than prevention. It would seem logical that to truly cut down the cost of healthcare in the United States, which should drive down costs to the consumer, we should turn our focus to prevention of chronic disease rather than focusing so heavily on treatment. 

Access to and affordability of healthcare are commonly considered the primary culprits to the U.S.’ poor health outcomes. While these are significant issues that we must continue to address, the lack of focus on integrated preventive care is one of the greatest challenges to public health. 

Integrative medicine emphasizes the patient and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person’s health. Primary care that focuses on prevention should include all these pieces of integrative care. In the realm of primary care, nurse practitioners are known for their focus on prevention rather than intervention.

Models are rolling out that include mental health and physical therapy fully immersed in the more traditional Western medicine idea of primary care. It’s important to note that in these models, mental health, and physical therapy, ideally, are not only reactionary. It isn’t about only treating patients when they have clinical depression or low back pain. It’s about building healthy habits into everyday life, and preferably preventing completely or at a minimum reducing the amount of time that a person suffers from any sort of mental, emotional, or physical distress. 

Finally, we must start to separate out what is truly preventive care versus screenings. While there are certainly valid recommendations for things like mammograms, colonoscopies, and sexually transmitted infections (STI) screenings, the use “preventive” in relation to screenings can be misleading. Catching these issues early can potentially help prevent more dire outcomes, but the screenings themselves do not prevent the issue from occurring.

Within this integrative, primary care model we need to focus on actual preventive medicine such as diet, exercise, avoidance of environmental toxins, sleep habits, and stress reduction. Having easy and affordable access to a powerhouse team of primary care providers, mental health, and musculoskeletal experts, who can support a patient through various stages of readiness on their wellness journey, is where we will start to lasting change. Nurse practitioners are equipped to drive this movement forward.

About the Expert

Genevieve Swenson, FNP-C, chief operating officer and co-founder COO of Nice Healthcare, is a Family Nurse Practitioner with a diverse background in the healthcare world has partnered with patients in clinics, in their homes, via telehealth, in urgent cares and employer wellness clinics.

Editor’s note: Practitioner Perspectives is a series where we highlight trending topics through interviews with integrative healthcare professionals. To participate, please email us at [email protected].