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Referring Provider Opinions of Pediatric Cardiology Evaluations Performed by Nurse Practitioners

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A Correspondence to this article was published on 14 November 2022

Abstract

In the setting of physician shortages, nurse practitioner (NP) roles have evolved, with increasing independence across most healthcare settings. We sought to characterize referring clinician perceptions of NP-performed outpatient pediatric cardiology consultations. We electronically distributed to pediatric and family medicine physicians and NPs in Arkansas our 11-item survey assessing the acceptability of pediatric cardiology consultations being completed by an NP under varying circumstances. Circumstances included seven common referral indications, and the scale offered five answer choices ranging from “definitely unacceptable” to “definitely acceptable”. A total of 292 of 1756 (16.6% response rate) referring clinicians responded to the survey. Overall, 57% of responses indicated that NP-completed pediatric cardiology evaluations were either definitely or probably unacceptable. Acceptability was varied by referral indication and referring clinician characteristics. Unacceptability of NP-completed pediatric cardiology evaluations was greatest among family medicine physicians (81%), pediatricians (66%), and clinicians working in solo or two-physician practices (77%) or community hospitals/clinics (71%). If NP evaluation of a murmur included required review with a cardiologist, the unacceptability rate dropped from 50 to 24% (p < 0.0001). Unacceptability was higher in physicians who do not work with NPs (69%) compared to those who do (60%) (pp < 0.0001). Many referring physicians were willing to send patients ≥ 100 miles to ensure evaluation by a pediatric cardiologist. Most referring physicians find pediatric cardiology evaluations performed by NPs to be unacceptable. Requisite review with a cardiologist improved acceptability of NP evaluations. Many referring physicians would send patients much farther to guarantee evaluation by a cardiologist.

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Abbreviations

NP:

Nurse practitioner

EKG:

Electrocardiogram

References

  1. Bregman S, Frishman WH (2018) Impact of improved survival in congenital heart disease on incidence of disease. Cardiol Rev 26(2):82–85

    Article  Google Scholar 

  2. Auerbach DI, Staiger DO, Buerhaus PI (2018) Growing ranks of advanced practice clinicians–implications for the physician workforce. N Engl J Med 378(25):2358–2360

    Article  Google Scholar 

  3. Freed GL, Dunham KM, Loveland-Cherry C, Martyn KK, Moote MJ (2011) Nurse practitioners and physician assistants employed by general and subspecialty pediatricians. Pediatrics 128(4):665–672

    Article  Google Scholar 

  4. Mark BA, Patel E (2019) Nurse practitioner scope of practice: what do we know and where do we go? West J Nur Res 41(4):483–487

    Article  Google Scholar 

  5. Cheyuo C, Brandmeir N, Fisher-Perez N, Dekeseredy P, Sedney C (2020) Patient acceptability of the use of advanced practice providers in an Outpatient Neurosurgery Clinic. Cureus 12(7):e9157

    Google Scholar 

  6. McCleery E, Christensen V, Peterson K, Humphrey L, Helfand M (2014) Evidence brief: the quality of care provided by advanced practice nurses. In: VA Evid Synthesis Program

  7. Tataw DB, Bazargan-Hejazi S, James FW (2011) Health services utilization, satisfaction, and attachment to a regular source of care among participants in an urban health provider alliance. J Health Hum Ser Utiliz 34(1):109–141

    Google Scholar 

  8. Evangelista JA, Connor JA, Pintz C, Saia T, O’Connell C, Fulton DR, Hickey P (2012) Paediatric nurse practitioner managed cardiology clinics: patient satisfaction and appointment access. J Adv Nurs 68(10):2165–2174

    Article  Google Scholar 

  9. Glenn JK, Lawler FH, Hoerl MS (1987) Physician referrals in a competitive environment. An estimate of the economic impact of a referral. JAMA 258(14):1920–1923

    Article  CAS  Google Scholar 

  10. Committee on Pediatric Workforce (2003) Scope of practice issues in the delivery of pediatric health care. Pediatrics 111(2):426–435

    Article  Google Scholar 

  11. Garcia RU, Peddy SB (2018) Heart disease in children. Prim Care 45(1):143–154

    Article  Google Scholar 

  12. Kilgore-Hill M (2021) Arkansas nurse practitioners—moving toward independence. Ar Med News

  13. American Association of Nurse Practitioner (2021) Planning Your Nurse Practitioner (NP) Education. Am Assoc Nurs Pract. https://www.aanp.org/student-resources/planning-your-np-education. Accessed 15 June 2021

  14. Kesten KS, El-Banna MM, Blakely J (2019) Educational characteristics and content of postgraduate nurse practitioner residency/fellowship programs. J Am Assoc Nurse Pract 33(2):126–132

    Article  Google Scholar 

  15. Turner A, Ricketts T, Leslie LK (2020) Comparison of number and geographic distribution of pediatric subspecialists and patient proximity to specialized care in the US between 2003 and 2019. JAMA Pediatr 174(9):852–860

    Article  Google Scholar 

  16. Pletcher BA, Rimsza ME, Cull WL, Shipman SA, Shugerman RP, O’Connor KG (2010) Primary care pediatricians’ satisfaction with subspecialty care, perceived supply, and barriers to care. Pediatrics 156(6):1011–1015

    Article  Google Scholar 

  17. Ray KN, Bogen DL, Bertolet M, Forrest CB, Mehrotra A (2014) Supply and utilization of pediatric subspecialists in the United States. Pediatrics 133(6):1061–1069

    Article  Google Scholar 

  18. Bohnhoff JC, Taormina JM, Ferrante L, Wolfson D, Ray KN (2019) Unscheduled referrals and unattended appointments after pediatric subspecialty referral. Pediatrics. https://doi.org/10.1542/peds.2019-0545

    Article  Google Scholar 

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Acknowledgements

The authors of this study would like to acknowledge the Arkansas chapters of the American Academy of Pediatrics and the American Academy of Family Physicians for distributing this email-based survey.

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA

    Lily Suh, Markus S. Renno, Elijah H. Bolin, Brian K. Eble, Sherry Pye & Joshua A. Daily

  2. Department of Pediatrics, Arkansas Children’s Hospital, 1 Children’s Way, Little Rock, AR, 72205, USA

    Lily Suh, Markus S. Renno, Elijah H. Bolin, Brian K. Eble, Sherry Pye & Joshua A. Daily

  3. Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, USA

    R. Thomas Collins II

  4. Lucile Packard Children’s Hospital, Palo Alto, USA

    R. Thomas Collins II

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  1. Lily Suh
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  2. Markus S. Renno
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  4. Brian K. Eble
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  5. R. Thomas Collins II
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  6. Sherry Pye
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  7. Joshua A. Daily
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Contributions

Dr. LS conceptualized and designed the study, designed the data collection instrument, collected data, carried out initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. JAD conceptualized and designed the study, designed the data collection instrument, carried out initial analyses, coordinated and supervised data collection, and reviewed and revised the manuscript. Dr. MSR conceptualized and designed the study, carried out initial analyses, and reviewed and revised the manuscript. Drs. EHB, BKE, RTC, and SP conceptualized and designed the study, and reviewed and revised the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

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Correspondence to Joshua A. Daily.

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Supplementary Information

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246_2022_2959_MOESM1_ESM.jpg

Supplementary file1 Supplemental Figure 1 Influence of clinician type on the acceptability of nurse practitioners seeing referrals to pediatric cardiology clinic for seven referral indications (JPG 1776 KB)

Supplementary file2 Supplemental Figure 2 Survey distributed to respondents (JPG 4922 KB)

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Suh, L., Renno, M.S., Bolin, E.H. et al. Referring Provider Opinions of Pediatric Cardiology Evaluations Performed by Nurse Practitioners. Pediatr Cardiol 44, 34–43 (2023). https://doi.org/10.1007/s00246-022-02959-0

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  • DOI: https://doi.org/10.1007/s00246-022-02959-0

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