Utilization of nurse practitioners in long-term care: findings and implications of a national survey

OBJECTIVES: The objective of this study was to determine the national practice patterns of nurse practitioners (NPs) providing care in long-term care (LTC) facilities, including the number and characteristics of LTC facilities that use NPs for any portion of care to residents, NP activities, and employment arrangements between NPs, physicians, and facilities. DESIGN: Mailed survey. PARTICIPANTS: Participants included all physicians who are members of the American Medical Directors Association (AMDA). MEASUREMENT: The survey instrument was constructed to obtain information in the following six domains: (1) the number of LTC facilities that have NPs involved in providing care; (2) the number of NPs engaged in care at these facilities; (3) the types of employment/financial arrangements between NPs and LTC facilities; (4) the types of services provided by the NPs; (5) the effectiveness of the NPs as perceived by the medical directors; and (6) the perceived future demand for NPs in LTC. RESULTS: Of a total of 870 respondents (response rate 19%), 546 respondents (63%) reported the involvement of NPs in the care of residents in their facilities. In total, respondents identified 1160 NPs involved in care, with a median of two NPs per responding facility (range, 1-10). Respondents reported that NPs make sick/urgent resident visits (96%), provide preventive care to long-stay residents (88%), and perform alternating required regulatory 30/60 (88%), hospice care (80%), and wound care (78%). Significant variations in practice patterns were found between NPs employed by a LTC facility (19% of respondents) as compared with those NPs employed in other arrangements. Large majorities of medical directors stated that NPs are particularly effective in maintaining physician satisfaction (90%), resident satisfaction (87%), and family satisfaction (85%). An additional 34% of the respondents projected an increased need for NPs in nursing homes in the future. CONCLUSION: NPs involved in LTC are more likely to be involved in the care of residents in the nation's larger (>100-bed) LTC facilities. The substantial number and types of services provided by these NPs, coupled with the high resident, family, and physician satisfaction with their services, suggests the need for educational, policy, and reimbursement strategies to encourage the further involvement of NPs in the care of residents in nursing homes.     

What aspects of treatment matter to the patient in the treatment of cocaine dependence?

Patient views of the helpful aspects of treatment were examined in the NIDA Collaborative Cocaine Treatment Study, a multi-site trial comparing four psychosocial treatments: individual cognitive therapy (CT), individual supportive expressive dynamic therapy (SE), individual drug counseling, and group drug counseling only, for the treatment of cocaine dependence. Factor analysis of the items of Helpful Aspects of Treatment measure suggested a general therapy factor, a group treatment/education factor, and a treatment structure factor. No differences were found among the four treatments on the ratings of helpfulness of these three factors, common factors, or drug intervention components. However, treatment specific cognitive therapy items (e.g. use of the cognitive model) and treatment structure differentiated individual CT from individual SE, and to a lesser extent from individual drug counseling. Ratings of helpfulness were significantly related to retention and alliance but were largely unrelated to changes in drug use or psychiatric outcomes.     

Family-Planning Practices Among Women With Diabetes and Overweight and Obese Women in the 2002 National Survey for Family Growth

OBJECTIVE

To examine contraceptive practices among diabetic women and obese women.

RESEARCH DESIGN AND METHODS

We analyzed the responses of 5,955 participants aged 20–44 years in the 2002 National Survey for Family Growth. Diabetes, BMI, desire for pregnancy, history of infertility treatment, sexual activity, parity, and demographic variables (age, race/ethnicity, education, marital status, income, insurance, and smoking history) were obtained by self-report. Lack of contraception was defined as absence of hormonal-, barrier-, or sterilization-based methods. Associations among contraception, diabetes, and BMI category were assessed in multivariable logistic regression models in nonsterile, sexually active women.

RESULTS

In unadjusted comparisons among sexually active women who were not sterilized, women with diabetes were more likely to lack contraception than women without diabetes (odds ratio [OR] 2.61 [95% CI 1.22–5.58]). Women with BMI ≥35 kg/m² were more likely to lack contraception than women with BMI <25 kg/m²(1.63 [1.16–2.28]), but associations between contraception use and lesser degrees of overweight and obesity were not significant. In multivariable models, women who were older (aged ≥30 vs. 20–29 years), were of non-Hispanic black race, were cohabitating, had a history of infertility treatment, and desired or were ambivalent about pregnancy were significantly more likely to lack contraception. The associations among diabetes, BMI, and contraception were no longer significant after these adjustments.

CONCLUSIONS

Older women with diabetes and obesity who desire pregnancy, regardless of pregnancy intention, should be targeted for preconceptive management.Diabetes and obesity increasingly affect women of reproductive age in the U.S. (1,2). Data from the National Health and Nutrition Examination Survey show that the prevalence of physician-diagnosed diabetes in women aged ≥20 years was 7.1% from 2001 to 2004 (3). Moreover, in 2003–2004, one in three women aged ≥20 years was identified as obese (BMI ≥30 kg/m²) (4). Women with diabetes and those who are obese are at increased risk for pregnancy complications, including those fromsurgical delivery, and their offspring areat riskfor congenital anomalies (5,6). Women with diabetes can improve pregnancy outcomes by delaying pregnancy until optimal glucose levels are reached (7). Obese women are also at risk for gestational diabetes mellitus and future onset of diabetes (8,9). Effective family planning, used in conjunction with glucose management for women with diabetes, as well as weight loss and diabetes screening before pregnancy, may reduce the risk to the mother and fetus associated with diabetes and obesity. In addition, family planning will reduce the risk of mistimed pregnancies (10).Between one-half and two-thirds of women with diabetes have experienced unplanned pregnancies (11–14). However, Chuang et al. (15) found that among sexually active women with diabetes, only a quarter reported no contraceptive use. Similarly, reports of contraceptive practices of obese women vary. While Chuang et al. (15) found that one-fifth of potentially fertile obese women reported no contraceptive use, other reports (16) have found much lower rates of contraception among obese women.It is also not clear to what extent diabetes or obesity are independent riskfactors for contraception nonuse. The objective of this study was to examine contraceptive nonuse and its associations with diabetes and categories of BMI using data from the 2002 National Survey for Family Growth (NSFG). We hypothesized that women with diabetes wouldreport less contraceptive use than nondiabetic women and that this difference would persist after adjustment for demographic factors and potential confounders, such as desire for pregnancy, history of infertility treatment, and obesity. We also hypothesized that overweight and obese women would report less frequent contraceptive use than healthy-weight women after adjustment for potential confounders.     

Development of the MASCC teaching tool for patients receiving oral agents for cancer

Background  

Oral agents for cancer treatment commonly are prescribed throughout the world. Since oral agents usually are self-administered or administered by lay caregivers, patient education is vital to help ensure that the oral agents are being stored, handled, and taken correctly. When oral agents are taken as prescribed and patients are well informed about signs and symptoms to report, patient outcomes are optimized. Patient education varies globally; consequently, there is a need for a consistent and comprehensive approach to educate patients about oral cancer treatment.