Advance Practice Providers in Rural Areas

From the NY Times:

The laws giving nurse practitioners greater autonomy have been particularly important in rural states like Nebraska, which struggle to recruit doctors to remote areas. About a third of Nebraska’s 1.8 million people live in rural areas, and many go largely unserved as the nearest mental health professional is often hours away.

“The situation could be viewed as an emergency, especially in rural counties,” said Jim P. Stimpson, director of the Center for Health Policy at the University of Nebraska, referring to the shortage.

Groups representing doctors, including the American Medical Association, are fighting the laws. They say nurses lack the knowledge and skills to diagnose complex illnesses by themselves. Dr. Robert M. Wah, the president of the A.M.A., said nurses practicing independently would “further compartmentalize and fragment health care,” which he argued should be collaborative, with “the physician at the head of the team.”

Minnesota Ruling May Give EPs Due Process Boost

From Emergency Medicine News:

The medical staff of a hospital or health system has standing to sue its hospital board, and medical staff bylaws constitute an enforceable contract. That 5-2 ruling from the Minnesota Supreme Court earlier this year, in a case involving the 25-bed Avera Marshall Regional Medical Center in Marshall, MN, has potentially far-reaching implications for physician autonomy and is particularly noteworthy for emergency physicians, said experts.

Smoking, Drug Abuse, Mental Illness Linked to Frequent ER Visits

From Psych Central:

Smokers, substance abusers, and patients with mental illness are three times more likely to become “frequent emergency room users,” meaning they visit the ER three or more times a year, according to a new study published in the journal Nursing Research.

Furthermore, within the general population, all medical services have seen a large increase in visits; this includes the ER as well as regular doctor visits.

Ohio lawmakers want to speed up trauma emergency transport

From the Times:

Two Ohio legislators are pushing for changes to how emergency workers deal with trauma victims in hopes to improve patient transportation.

Their bill, which is expected to be introduced in the Ohio House soon, would require victims to be transported directly to the closest appropriate trauma center immediately following an emergency, the Columbus Dispatch reported ( It would also create a state trauma board.

Poor Residents Benefit From Medicine Recycling

From NPR:

Tulsa County, Okla. was an early adopter of a technique that is now common. The head of the county health department noticed that poor people were having trouble coming up with the cash to pay for prescription medicines. They couldn’t even pay at the low-cost, county-run pharmacy. The county found a source of free medicine. County social services director Linda Johnston says she uses a network of retired doctors to collect unused medicines from nursing homes and other long-term care facilities.

Event recap: Next steps for integrated emergency medicine

From the Brookings Institute:

Recently, the Richard Merkin Initiative on Payment Reform and Clinical Leadership hosted, “MEDTalk – Reimagining emergency medicine: How to integrate care for the acutely ill and injured.” Emergency medicine includes a range of care, from a child presenting with an earache and fever to car crash victims that require level 1 trauma care.

Smokers four times more likely to be ED ‘super users’

From Futurity:

Smokers are four times more likely than non-smokers to frequently visit emergency rooms.

A new study, which explores how much patients replace visits to a primary care physician with a trip to a hospital emergency room, also shows Americans with chronic diseases use both services equally.

In fact, overall, medical care visits of all types have soared in recent years.

“There are a few super-users who have been in the ER 40 or 50 times, but when we step back and look at the whole population, we see a different pattern,” says Jessica Castner, assistant professor of nursing at University at Buffalo. “People aren’t replacing their doctor; they are sicker, have more chronic diseases, and are using everything more.”


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