BACKGROUND: Shortages currently exist among neurologists who provide care for individuals with multiple sclerosis (MS). Advanced practice providers (APPs, i.e., Nurse Practitioners [NPs] and Physician Assistants [PAs]) contribute to multidisciplinary teams and complement the MS physician workforce. Despite experiencing barriers to providing MS care, APPs are interested in providing services for individuals with MS. Understanding these barriers may identify strategies to encourage APPs to pursue careers in MS care and receive related training.
OBJECTIVES: To examine the barriers and facilitators APPs experience in providing care for MS patients.
METHODS: From November 2016-April 2017, we administered 2 web-based surveys, one for NPs and one for PAs. Recruitment occurred via emails from professional society listservs/email blasts and via direct email using a proprietary database. A total of 215 NPs and 395 PAs completed the surveys. The survey assessed barriers and facilitators to providing MS patient care and clinical services APPs provide for individuals with MS.
RESULTS: We examined 3 composite barrier measures for providing MS care: 1) lack of knowledge or training; 2) lack of resources to provide treatment; and 3) patient complexity. PAs were more likely to report lack of knowledge (12% NPs, 34% of PAs) and lack of resources to provide treatment (11% NPs, 20% PAs) as barriers. Patient complexity as a barrier had similar rates between both groups (19% NPs, 20% of PAs). NPs and PAs had similar rates of reported facilitators for providing MS care: 1) ability to improve patient outcomes and quality of life (93% NPs, 97% PAs); 2) dynamic area with evolving treatment options (62% NPs, 69% PAs); 3) care involving a multidisciplinary team (66% NPs, 64% PAs); 4) enjoy interacting with patients with neurological conditions (61% NPs, 74% PAs); and 5) community of dedicated professional colleagues with which to interact (51% NPs, 39% PAs). In regression analyses for NPs, lack of knowledge or training was associated with decreased likelihood of seeing or managing care for MS patients. For PAs, lack of knowledge or training was associated with decreased likelihood of providing several types of services to individuals with neurological conditions or MS.
CONCLUSION: APPs provide a range of clinical services and can support the MS physician workforce. Interventions to improve knowledge or training among NPs and PAs may improve MS patient care.
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