Nurse Practitioner Work Environment and Rural Primary Care for Substance Use

Area of Science:

• Healthcare access
• Rural health
• Substance use disorders

Background:

• Rural older adults with substance use disorders (SUD) face significant barriers to primary care.
• Nurse practitioner (NP) work environments are crucial for healthcare delivery but their impact on this population is understudied.

Purpose of the Study:

• To investigate the association between the NP work environment and primary care access for rural older adults with SUDs.
• To identify key components of NP work environments that facilitate care utilization.

Main Methods:

• Cross-sectional analysis of NP survey data linked with Medicare claims.
• Fractional logistic regression was used to model the relationship between NP work environment and primary care utilization.

Main Results:

• A one-unit increase in the NP work environment score was associated with a 20% increase in the odds of primary care access for rural older adults with SUDs (aOR=1.20, CI=1.01-1.44, p=0.04).
• Favorable NP work environment factors include organizational support, collegiality, and role visibility.

Conclusions:

• Improving NP work environments can enhance primary care access for rural older adults with SUDs.
• Organizational support, collegiality, and role visibility are key factors in NP work environments that promote care utilization.