• Impact of State Nurse Practitioner Practice Authority on Mental Health Service Delivery

      Yang, Bo Kyum; Trinkoff, Alison M. (2017)
      Background: The involvement of nurse practitioners (NPs) in mental healthcare has become increasingly important, given their expanded scope of practice and growing mental healthcare demand. Nonetheless, little is known about whether NP-independent practice authority (NP-IPA) influences the role of NPs in mental healthcare for underserved populations. Purpose: The major purpose of this study was 1) to determine if NP-IPA status was associated with the proportion of mental healthcare provided by NPs in US community health centers (CHCs) and 2) to characterize trends and patterns of psychotropic medication prescriptions by NPs compared to physicians for Medicaid insured youth. Methods: The study used two national surveys and a mid-Atlantic state Medicaid insurance claims dataset. Descriptive statistics were performed to describe trends and patterns of mental healthcare provided by NPs compared to physicians. The adjusted odds of mental health visits within CHCs provided by NPs in states with NP-IPA were compared to the odds in states without NP-IPA, using multiple logistic regression while accounting for the complex survey design. Results: From 2012 to 2014, there was a 3.7% proportional increase in psychotropic medication prescriptions by NPs, while physician-written prescriptions declined by 4.8% in Medicaid insured youth. Overall, a similar prescribing pattern was found between physicians and NPs by specialty, whereas there were notable differences in prescribing patterns by psychiatric versus non-psychiatric specialties. The odds of NP- versus physician-provided mental health visits were two times greater in states with NP-IPA than in comparison states between 2006 and 2011. Among all mental disorder-related visits, the odds of having NP visits with psychotropic medications were three times higher in states with NP-IPA than in comparison states. In contrast, there was no significant difference in non-mental health visits provided by NPs over time. Conclusion: Findings suggest that NP-IPA can expand NP contributions to mental health service delivery in CHCs. For Medicaid insured youth, NPs overall, and especially psychiatric NPs, played an increasing role in psychotropic medication prescribing from 2012 to 2014; these NPs exhibited similar prescribing patterns compared to physicians. Future studies evaluating the quality of NP-provided mental healthcare under NP-IPA could extend these findings.