title: Access to care based on state nurse practitioner practice regulation: secondary data analysis results in the Medicare population.
abstract: OBJECTIVE
  To examine access to care in the Medicare population based on state nurse practitioner (NP) practice regulation.
  
  
  METHODS
  Secondary data analysis of the Medicare Current Beneficiary Survey Access to Care 2011 dataset. Items used to measure access to care were usual source of care, appointment waiting times, and difficulties encountered. States were designated as full, reduced, or restricted NP practice based on data from the American Association of Nurse Practitioners State Regulatory Map.
  
  
  CONCLUSIONS
  Self-reported usual source of care (N = 1,496,251) was not significantly affected by state regulation (p > .05); however, these results were based on only 3% of the sample answering the question. Significant differences were seen in sites for care across state groups (N = 41,650,566, p ≤ .01). Participants in reduced (B = -1.86) and restricted (B = -2.82) states reported lower waiting times than those in full practice states (N = 371,166, p < .01). Participants in reduced practice states had 67% lower odds of having trouble accessing care than participants in full practice states (N = 5,568,495, p = .01). More participants in restricted and reduced states reported cost as a difficulty (N = 1180, p = .03).
  
  
  CONCLUSIONS
  Access to care based on state NP practice regulation is an important area of study because of the changing nature of health care and the growing support for full practice. This study examined access to care in states with different levels of NP practice regulation, but did not directly measure outcomes in individuals based on NP care. Additional research is needed to examine the impact of state regulation in different patient populations (self-insured, Medicaid, uninsured), and changes in access to care over time as state regulations change.
authors.affiliation: University of Missouri-Kansas City, Kansas City, Missouri; School of Nursing, Murray State University, Murray, Kentucky.
authors.forename: Summer
authors.initials: S
authors.lastname: Cross
authors.forename: Patricia
authors.initials: P
authors.lastname: Kelly
mesh_terms: D005260:Female; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence* / Q000592:standards; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009722:Nurse Practitioners / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012926:Social Control, Formal / Q000379:methods*; D013221:State Health Plans / Q000592:standards / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States
keywords: Healthcare delivery; health policy; legislation; nurse practitioners; primary care