Health Professional Shortage Areas (HPSAs) are regions, groups, or institutions that lack sufficient access to primary medical care.
APRNs in Missouri can act as primary care providers for acute, gynecological, and pain management care.
APRNs in MO are subject to restricted practice laws that require them to collaborate with a physician to provide certain forms of care. Collaborating physicians must: (1) not collab-orate with more than six APRNs at a time, (2) be located within 75 miles from APRNs they super-vise, (3) review at least 10% of the APRNs’ health care charts and 20% of prescriptions of control-led substances every 14 days, and (4) supervise APRNs in-person for 1-month before allowing the APRN to practice independently or administer, dispense, or prescribe a controlled substance.
APRNs in 26 states and D.C. have full practice authority, meaning that they can independently diagnose, treat, and prescribe to patients with-out physician oversight (Figure 1) (AANP 2023).
States with full practice authority have more APRNs and healthcare delivery to rural (up to 5%↑) and low-income areas (up to 8% ↑), and HPSAs (up to 2% ↑) (Yang 2021; Poghosyan 2019; US DHHS 2015; Grumbach 2003).
Less restrictive APRN laws can increase the supply of APRNs to areas with low access to telehealth and transportation (MORH 2017). These laws do not increase the cost of physician care and, can lower costs for some services (Abraham 2019; Adams 2018).
Figure 1. Map of APRN scope of practice laws. Twenty-six states and Washington D.C. grant APRNs full practice authority (green), 13 states (yellow) limit at least one aspect of practice and 11 states (red), including MO, limit most aspects of APRN practice and require career-long supervision. Data from the American Association of Nurse Practitioners.
Licensed APRNs in the US grew by 50% between 2008-2016. States with full practice authority have the highest number of APRNs, while the fastest percentage growth of licensed APRNs occurred in states with more restrictive scopes of practice (Barnes 2018).
Most studies only compare patient out-comes, quality and cost between states with full APRN authority and restricted practice laws.
In 2013, 15 of 24 states (63%) with restrictive practice laws had APRN shortages, while 8 of 26 states (31%) with full practice authority had workforce shortages, suggesting other factors like reimbursement rates for services (85% for Medicaid patients), infrastructure for telehealth and electronic records, aging patient populations, and state residency requirements can also contribute to short-ages (US DHHS 2016).
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