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Kentucky law grants prescribing authority to nurses

A new Kentucky state law that expands prescribing authority for advanced practice registered nurses took effect Tuesday, the same day that a study was published touting the benefits of having nurses manage care for patients with chronic conditions such as diabetes and high blood pressure.

The measure, signed by Gov. Steve Beshear in February, represented a compromise after years of contentious debate. After the close of the 2013 legislative session, legislative leaders instructed the Kentucky Medical Association, Kentucky Academy of Family Physicians and the Kentucky Coalition of Nurse Practitioners and Nurse Midwives to settle their differences on the issue.

“I appreciate the way this bill was handled in the legislative process. The compromise was negotiated until all interested parties were comfortable,” the bill's sponsor, Republican state Sen. Paul Hornback, said in a news release.

The law allows nurse practitioners to prescribe independently after prescribing under physician supervision for four years. If NPs from another state have been prescribing either independently or under supervision for four years, they are eligible to prescribe in Kentucky. It also establishes a six-person Collaborative Prescribing Agreement Joint Advisory Committee composed of three APRNs with prescribing experience and three physicians with APRN-supervision experience.

Beshear touted the law's ability to expand patient access to antibiotics and for drugs to treat diabetes, high cholesterol and hypertension.

A Veterans Affairs Department-funded study published in the July 15 Annals of Internal Medicine reviewed 18 previous studies, published between 1994 an 2011, where a nurse following a protocol adjusted patient medication levels.

“A team approach that uses nurse-managed protocols may have positive effects on the outpatient management of adults with chronic conditions, such as diabetes, hypertension and hyperlipidemia,” suggested the report, written by researchers at the Durham (N.C.) VA Medical Center and Duke University.

Referring to them as “the largest healthcare workforce group,” the authors wrote that nurses “are in an ideal position to collaborate” with other healthcare-team members to deliver more accessible and effective chronic-disease care.

Physicians from Hofstra North Shore–Long Island Jewish School of Medicine, Hempstead, N.Y., agreed with this assessment in an accompanying editorial.

“Like it or not, outpatient medicine has become too complicated for physicians to handle by themselves,” wrote Drs. Sandeep Jauhar and David Battinelli. “We need new models of primary care, and enlisting nurses will be central to this effort.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks

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