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Theoretical Framework: The Interprofessional Teamwork in Healthcare Settings Model guided the study. Background: The primary care system is strained by an increased demand for care because of an aging population, high prevalence of chronic illness, and limited supply of primary care providers. Expanding the nurse practitioner (NP) workforce and developing team-based care delivery models are two intricately related approaches to ensuring the primary care system is adequately prepared for the increased volume of patients. To date little is known about teamwork between NPs and physicians in primary care. Purpose: We used a mixed method research design to explore interprofessional teamwork among NPs and primary care physicians. Methods: We used 2 data sources. The first source consisted of transcripts of 16 individual qualitative interviews with primary care NPs practicing in Massachusetts. The interviews explored NPs' perceptions of their practice, relationships between team members, and organizational context. The second dataset consisted of survey data collected from 314 NPs from the same state regarding aspects of their practices and their relationship with physicians, administrators, and others. We used the Interprofessional Teamwork in Healthcare Settings Model to develop each of the model's components as thematic areas related to factors facilitating teamwork We examined survey items and grouped them according to the dimensions of the model. We discussed them and consensus was achieved regarding the items mapping on domains. We integrated the results from the qualitative interviews and survey using a mixed-mode approach. The thematic areas were developed from the qualitative data and the survey data was used to illustrate the results in the qualitative data and vice versa. Results: NPs participating in both the individual in-depth interviews and mail surveys had similar demographic characteristics. The four domains in the model emerged from our data as important factors for teamwork in primary care. In the relational domain, the relationship between NPs and physicians was rated rated favorably; however, challenges were observed in the relationship between NPs and administrators. NPs reported their role being not clear within their organizations, not being able to practice within their scope of practice and lack adequate organizational support. Conclusions/Implications: Physicians are supportive of NP practice. The relationship evolves over time and the longer NPs and physicians practice together, the greater is the likelihood of them developing similar practices of caring for patients and effective relationships. It is crucial for leadership to effectively promote team structures through NP support in the organizations. It is recommended that this be achieved through increased awareness of NP skills and involvement of NPs in organizational committees. More research is needed to better understand how to promote teamwork to benefit patient care. [ABSTRACT FROM AUTHOR]

Background/Purpose: The Nurse Practitioner (NP) workforce represents a substantial supply of primary care providers able to contribute to meeting a growing demand for care. However, controversy exists regarding widening scope of practice and autonomy of NPs in primary care in terms of challenging the teamwork between NPs and physicians. To date no empirical evidence exists regarding how NP autonomy and independent practice influence teamwork. We investigated whether NP autonomy and independent practice in primary care practices and the relationships NPs have with leadership affect teamwork between NPs and physicians. Methods: Using a cross-sectional survey design, data was collected from 163 primary care practices in Massachusetts. Three hundred fourteen primary care NPs completed and returned the mail survey yielding a response rate of 40%. The Autonomy and Independent Practice (AIP) and NP-Administration Relations (NP-AR) scales were used to measure NP autonomy and independent practice and the relationships with leadership, respectively. These measures were aggregated to the organizational-level. Teamwork between NPs and physicians was measured at the individual NP-level using the Teamwork (TW) scale. We used multilevel regression models to investigate the influence of organization-level NP autonomy and independent practice and the relationship between NPs and leadership on teamwork between NPs and physicians. Results: The average age of NPs was 49 years with the vast majority being female (97.3%) and white (93.3%). Forty-seven percent of NPs practiced in physician offices. AIP, NP-AR, and TW scales had acceptable internal consistency reliability with Cronbach's alphas greater than 0.80. The items measuring NP autonomy were ranked highly by NPs. Compared to the items on the AIP scale, the items on the NP-AR scale had lower mean scores. Administration sharing information with NPs and physicians in the same manner and treating them similarly were low-ranking items in comparison to other NP-AR items. The multilevel models demonstrated that with every unit increase on the organizational-level mean score of AIP, the mean TW score increased by 0.27 units. With every unit increase of NP-AR, the mean TW score increased by 0.37. Over one-third (41.3%) of the variance in teamwork could be explained by the final model. Conclusions/Implications: The study findings demonstrate that NPs' ability to practice independently and favorable relationships with leadership improved teamwork. Policy change should focus on promoting NP autonomy and improving the relationship between NPs and leadership to consequently promote teamwork. While an increase in the number of NPs may alleviate a portion of access to care and quality of care issues facing primary care, a more long-term strategy is to determine the appropriate and effective mix of clinicians comprising primary care teams. More research is needed to better understand teamwork from the perspectives of physicians. [ABSTRACT FROM AUTHOR]

Background: Older adults from specific racial and ethnic minoritized groups experience disproportionately higher asthma prevalence, morbidity, and mortality. They also often use emergency departments (EDs) to manage their asthma. High-quality primary care can improve asthma control and prevent ED use. Nurse practitioners (NPs) provide an increasing proportion of primary care to minoritized patients, yet often, they work in poor work environments that strain NP care., Objectives: We examined whether racial and ethnic health disparities in ED visits among older adults with asthma are moderated by the NP work environment in primary care practices., Methods: In 2018-2019, we used a cross-sectional design to collect survey data on NP work environments from 1,244 NPs in six geographically diverse states (i.e., Arizona, California, New Jersey, Pennsylvania, Texas, and Washington). We merged the survey data with 2018 Medicare claims data from 46,658 patients with asthma to assess the associations of all-cause and ambulatory care-sensitive conditions, ED visits with NPs' work environment, and race and ethnicity using logistic regression., Results: More than one third of patients with asthma visited the ED in 1 year, and a quarter of them had an ambulatory care sensitive condition ED visit. Black and Hispanic patients were more likely than White patients to have all-cause and ambulatory care sensitive condition ED visits. NP work environment moderated the association of race with all-cause and ambulatory care sensitive condition ED visits among patients with asthma. Greater standardized NP work environment scores were associated with lower odds of all-cause and ambulatory care sensitive condition ED visits between Black and White patients., Discussion: Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with more favorable NP work environments. Preventing unnecessary ED visits among older adults with asthma is a likely benefit of favorable NP work environments. As the NP workforce grows, creating favorable work environments for NPs in primary care is vital for narrowing the health disparity gap., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)