Central PA Medicine Fall 2017 - 37

daup h i n c m s .o rg

Regardless, as of now, based on the existence of
the collaborative agreement, the doctor-patient
relationship remains intact in Pennsylvania. That
is not true for many states especially in the western
part of the country where independent practice
exists for CRNPs.
The collaborative agreement and the doctor-patient relationship are at risk, however, because a
bill granting independent practice is currently
floating through the Pennsylvania legislature
just a few votes from being sent to the governor.
The individuals supporting an elimination of the
collaborative agreement tout studies that appear
to demonstrate no difference between the care
given by a CRNP and a primary care physician.
Most studies, however, were observational utilizing 3397 patients were screened but only 1316 out of the way areas any more than physicians
surveys to determine wellness and satisfaction with were included in the study. Lastly, New York since there is no requirement for them to do so.
care. Furthermore, many of the clinical endpoints is a state that requires a collaborative agreement Most nurse practitioners currently are found in
such as blood pressure and glucose control are and there were no obvious controls for utilizing urban areas. As for not being able to contact
commonly protocol driven, and as I describe the collaborating physician in those patients the collaborating physician; that can be rectified
below, may not be the appropriate indicators for cared for by the nurse practitioners.
by the development of a cohesive relationship
the need for a collaborative agreement. One of
between the nurse practitioner and physician
the most cited studies, using the most commonly
What are the goals of a collaborative agreement? along with the placement of a successful contact
utilized study design and endpoints, is from 2000 To allow an extension of patient care utilizing mechanism. Also in Pennsylvania, so as not
by Mary O. Mundinger, Dean Emerita of the CRNPs, but, still having a level of easily attainable to limit healthcare delivery, meetings and case
Columbia School of Nursing, and colleagues physician oversight especially with more complex discussions on "a regularly scheduled basis" are
entitled "Primary Care Outcomes in Patients cases or those patients with illnesses not easily defined within each collaborative agreement and
Treated by Nurse Practitioners or Physicians: diagnosable. That being true, it is obvious why not by regulation or law.
A Randomized Trial." Patients in an urban endpoints such as blood pressure or glycosylated
environment were interviewed and physiologic hemoglobin are not appropriate to compare
Patients understand more likely than not that
test results were examined at six months after equality of care or the need for a collaborative they are being treated by a mid-level provider, but,
initial evaluation, and healthcare utilization agreement. Furthermore, utilizing the collabo- they assume and are comforted by the knowledge
data was recorded at six months and one year. rating physician could and should decrease the that a team approach exists lead by a physician.
There was no significant difference in health need for physician specialist consultation along They are less likely, however, to know that the
status and satisfaction based on the surveys and with the added healthcare expense.
medical team may be in jeopardy.
no difference in glucose control or healthcare
utilization. Diastolic blood pressures were lower
Common complaints about the collaborative
Without enough (or any) well performed
under the care of the nurse practitioners (82 mm agreement noted by CRNPs are unavailability studies assuring that major acute illness leading
Hg vs. 85 mm Hg).
of collaborating physicians based on geographic to significant morbidity or mortality is avoided
limitations or limitations on the number of equally between nurse practitioners without a colWhat are possible limitations, however, of this collaborative agreements that physicians can laborative agreement and primary care physicians,
study (and many of the studies)? Again, much have, inability to contact the collaborating and without evidence that healthcare accessibility
is based on survey results. In this case, 90% physician, and that collaboration in general limits is truly compromised due to the presence of a
of the population was only Spanish speaking healthcare. In Pennsylvania, however, there are collaborative agreement in Pennsylvania; removing
and the results had to be then translated into no geographical restrictions and there are no the collaborative agreement requirement for any
English with possible variability in translating defined limits on the number of collaborating reason or after any specified time adds no benefit
the responses. Healthcare utilization may be agreements a physician can have. Therefore, there to patient care in our commonwealth. (1)
skewed due to ethnic norms and access as well. should be no limitations on healthcare delivery
Answine, J. F., Is Collaboration Necessary or Even Helpful?,
The tests used to determine outcome were even in the far rural areas that need primary Sentinel: Pennsylvania Society of Anesthesiologists Newsletter
narrowly focused on blood pressure, glycosylated care providers. Furthermore, who is to say (Fall, 2017)
hemoglobin and peak flow rates for asthmatics. that a nurse practitioner will venture into those

Central PA Medicine Fall 2017 37


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Table of Contents for the Digital Edition of Central PA Medicine Fall 2017

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https://www.nxtbook.com/hoffmann/CPAMed/CPMWinter2021
https://www.nxtbook.com/hoffmann/CPAMed/CPMFall2020
https://www.nxtbook.com/hoffmann/CPAMed/CPMSummer2020
https://www.nxtbook.com/hoffmann/CPAMed/CPMSpring2020
https://www.nxtbook.com/hoffmann/CPAMed/CPMWinter2020
https://www.nxtbook.com/hoffmann/CPAMed/CPMFall19
https://www.nxtbook.com/hoffmann/CPAMed/CPMSummer19
https://www.nxtbook.com/hoffmann/CPAMed/CPMSpring19
https://www.nxtbook.com/hoffmann/CPAMed/CPMWinter19
https://www.nxtbook.com/hoffmann/CPAMed/CPMFall18
https://www.nxtbook.com/hoffmann/CPAMed/Summer2018
https://www.nxtbook.com/hoffmann/CPAMed/CPMSpring18
https://www.nxtbook.com/hoffmann/CPAMed/CPMWinter18
https://www.nxtbook.com/hoffmann/CPAMed/Fall2017
https://www.nxtbook.com/hoffmann/CPAMed/CentralPAMedicine_Summer17
https://www.nxtbook.com/hoffmann/CPAMed/CentralPAMedicine_Spring17
https://www.nxtbook.com/hoffmann/CPAMed/CentralPAMedicine_Feb2017
https://www.nxtbookmedia.com