Structure, process and outcomes of APNs’ prescriptive practices

2.50
Hdl Handle:
http://hdl.handle.net/10755/148376
Type:
Presentation
Title:
Structure, process and outcomes of APNs’ prescriptive practices
Abstract:
Structure, process and outcomes of APNs’ prescriptive practices
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Fineout-Overholt, L.
P.I. Institution Name:University of Rochester
Objective: The manner in which pharmaceuticals are prescribed is changing, including increased employment of Advanced Practice Nurses (APNs) with prescription responsibilities and the utilization of new models of pharmacy support services. However, while there has been some research investigating the factors associated with physician prescribing practices, there is little published research investigating factors influencing the pharmaceutical prescribing practices of APNs and the related patient outcomes. The purpose of this study was to explore the relationships among the structure, process and outcomes of APN prescriptive practices. Design: We employed a prospective, cross-sectional design using structural equation modeling and descriptive statistics. Setting: This study was conducted in a tertiary care medical center. Sample: Participants were sampled from interdisciplinary teams of 55 pharmacists and 204 APNs in 37 group practices. Names of Variables: Structure of care included environment, working relationships, and pharmacy service model. Process of care variables were subdivided into interpersonal processes of care, including regulations, collaboration, and alternative treatments, and technical processes of care, that is the diversity of the prescriptive practices of the APN. Outcome variables included overall pharmaceutical costs, patient satisfaction and clinical outcomes, such as adverse drug reactions, secondary diagnoses and hospital readmissions. Measures/Instruments: Structure and process measures were self-report questionnaires modified from the Kramer Nursing Work Index, (subscale reliability coefficients ranged from .89 to .93) and included both valued and present factors. Outcome data were obtained from existing automated databases routinely collected by the hospital, some of which are derived from the billing system. Findings: Our APN return rate was 45%. Most of the APNs were Masters prepared (66%, n= 54). Our return rate from pharmacists was 44%. The majority of pharmacists earned a PharmD (37%, n=9). In addition, most reported working in a specialty practice (67%, n=16). There were significant differences in what APNs and pharmacists valued and reported being present in the structure of care (p <0.001). The most frequent influences in APNs prescriptive practice were published research (mean=2.2, SD=.79) and collaboration with physicians (mean=2.1, SD=.74). Exercise was the most common alternative treatment prescribed (mean=2.0, SD=.86). The preliminary measurement model had adequate fit (c2=20.72, df 18, ns). Conclusions: This research has provided needed knowledge regarding APN prescriptive practices. While indirectly measured outcomes related to APN prescriptive practices are helpful at this preliminary stage, further work needs to be done to promote recognition of APNs’ contributions to patient care through formal inclusion of these providers in the databases used to gather outcome data. Implications: This theoretically derived research has the potential to provide knowledge for the development of evidence-based interventions that promote high-quality, cost-effective prescriptive practices of APNs. Knowledge generated from this study may inform APNs, nursing administrators, pharmacists, and physicians in how best to care for their patients. In addition, interventions in processes of care and changes in organizational structures to foster cost-effective pharmaceutical prescribing practices by APNs may be also prompted by the knowledge from this study.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleStructure, process and outcomes of APNs’ prescriptive practicesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/148376-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Structure, process and outcomes of APNs&rsquo; prescriptive practices</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Fineout-Overholt, L.</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Rochester</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">ellen_fineout@urmc.rochester.e</td></tr><tr><td colspan="2" class="item-abstract">Objective: The manner in which pharmaceuticals are prescribed is changing, including increased employment of Advanced Practice Nurses (APNs) with prescription responsibilities and the utilization of new models of pharmacy support services. However, while there has been some research investigating the factors associated with physician prescribing practices, there is little published research investigating factors influencing the pharmaceutical prescribing practices of APNs and the related patient outcomes. The purpose of this study was to explore the relationships among the structure, process and outcomes of APN prescriptive practices. Design: We employed a prospective, cross-sectional design using structural equation modeling and descriptive statistics. Setting: This study was conducted in a tertiary care medical center. Sample: Participants were sampled from interdisciplinary teams of 55 pharmacists and 204 APNs in 37 group practices. Names of Variables: Structure of care included environment, working relationships, and pharmacy service model. Process of care variables were subdivided into interpersonal processes of care, including regulations, collaboration, and alternative treatments, and technical processes of care, that is the diversity of the prescriptive practices of the APN. Outcome variables included overall pharmaceutical costs, patient satisfaction and clinical outcomes, such as adverse drug reactions, secondary diagnoses and hospital readmissions. Measures/Instruments: Structure and process measures were self-report questionnaires modified from the Kramer Nursing Work Index, (subscale reliability coefficients ranged from .89 to .93) and included both valued and present factors. Outcome data were obtained from existing automated databases routinely collected by the hospital, some of which are derived from the billing system. Findings: Our APN return rate was 45%. Most of the APNs were Masters prepared (66%, n= 54). Our return rate from pharmacists was 44%. The majority of pharmacists earned a PharmD (37%, n=9). In addition, most reported working in a specialty practice (67%, n=16). There were significant differences in what APNs and pharmacists valued and reported being present in the structure of care (p &lt;0.001). The most frequent influences in APNs prescriptive practice were published research (mean=2.2, SD=.79) and collaboration with physicians (mean=2.1, SD=.74). Exercise was the most common alternative treatment prescribed (mean=2.0, SD=.86). The preliminary measurement model had adequate fit (c2=20.72, df 18, ns). Conclusions: This research has provided needed knowledge regarding APN prescriptive practices. While indirectly measured outcomes related to APN prescriptive practices are helpful at this preliminary stage, further work needs to be done to promote recognition of APNs&rsquo; contributions to patient care through formal inclusion of these providers in the databases used to gather outcome data. Implications: This theoretically derived research has the potential to provide knowledge for the development of evidence-based interventions that promote high-quality, cost-effective prescriptive practices of APNs. Knowledge generated from this study may inform APNs, nursing administrators, pharmacists, and physicians in how best to care for their patients. In addition, interventions in processes of care and changes in organizational structures to foster cost-effective pharmaceutical prescribing practices by APNs may be also prompted by the knowledge from this study.</td></tr></table>en_GB
dc.date.available2011-10-26T09:44:15Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T09:44:15Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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