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      Nurse Practitioners and Virtual Care: A 50-State Review of APRN Telehealth Law and Policy

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          Abstract

          The healthcare industry is bracing for a predicted shortage of primary care physicians at a time when the telehealth industry is predicted to explode. Advance practice registered nurses (APRNs), who combine clinical expertise with an added emphasis on disease prevention and health management, have long been providing high-quality healthcare in the United States and will likely play a key role in assisting to alleviate this anticipated shortage. Approximately 86% of APRNs are certified in an area of primary care, and the workforce continues to grow with over 26,000 new APRNs completing their academic programs in 2017. Empowering APRNs to provide care via telehealth will extend the reach of their expertise and further expand access to care. Before providing care via telehealth, APRNs must be well versed in the laws, regulations, and policies affecting their practice when using this modality, especially since these can vary significantly between states. To this end, a 50-state review of APRN legislation, advisory opinions, policy statements, and telehealth legislation as it pertains to APRNs was conducted. The findings illustrate a wide array of APRN telehealth policies and regulations, ranging from no APRN telehealth provisions to detailed guidelines established in statute. State-by-state findings are summarized while identifying the various resources that should be considered when reviewing APRN telehealth practice policy. Recommendations to foster telehealth adoption by APRNs through legislative means are also provided.

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          Telemedicine is as effective as in-person visits for patients with asthma

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            Utilization of Telemedicine Among Rural Medicare Beneficiaries.

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              Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review

              Objective To determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care. Design A systematic review of randomised controlled trials reported since 1980. Data sources 10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites. Included studies Randomised controlled trials that evaluated nurse practitioners in alternative and complementary ambulatory care roles and reported health system outcomes. Results 11 trials were included. In four trials of alternative provider ambulatory primary care roles, nurse practitioners were equivalent to physicians in all but seven patient outcomes favouring nurse practitioner care and in all but four health system outcomes, one favouring nurse practitioner care and three favouring physician care. In a meta-analysis of two studies (2689 patients) with minimal heterogeneity and high-quality evidence, nurse practitioner care resulted in lower mean health services costs per consultation (mean difference: −€6.41; 95% CI −€9.28 to −€3.55; p<0.0001) (2006 euros). In two trials of alternative provider specialised ambulatory care roles, nurse practitioners were equivalent to physicians in all but three patient outcomes and one health system outcome favouring nurse practitioner care. In five trials of complementary provider specialised ambulatory care roles, 16 patient/provider outcomes favouring nurse practitioner plus usual care, and 16 were equivalent. Two health system outcomes favoured nurse practitioner plus usual care, four favoured usual care and 14 were equivalent. Four studies of complementary specialised ambulatory care compared costs, but only one assessed costs and outcomes jointly. Conclusions Nurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider specialised ambulatory care roles is promising, but limited by the few studies. While some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study.
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                Author and article information

                Journal
                TMT
                Telehealth and Medicine Today
                Partners in Digital Health
                2471-6960
                28 June 2019
                2019
                : 4
                : 10.30953/tmt.v4.136
                Affiliations
                [1 ]Medical University of South Carolina Center for Telehealth, USA
                [2 ]Medical University of South Carolina College of Nursing, USA
                Author notes
                Corresponding Author: Kelli Garber, Email: garberk@ 123456musc.edu
                Article
                136
                10.30953/tmt.v4.136
                c1bfd09a-389a-4a0e-8394-2a8cfcfea3df
                © 2019 Kelli Garber

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, adapt, enhance this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Categories
                Review Article

                Social & Information networks,General medicine,General life sciences,Health & Social care,Public health,Hardware architecture
                Regulation,Telemedicine Position Statements,Telemedicine Board of Nursing,Telemedicine Board of Medicine,Telemedicine Advisory Opinions,Telemedicine Acts,Telehealth,Policy,Nurse Practitioner,Nurse Practice Acts,Medical Practice Acts,Legislation,APRN

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