The Influence of Veterans Affairs' Full Practice Authority Policy Change on Access to Primary Health care
Authors: Crowder‐Martin T. , Richard P. , Hirsch R. 
Published: August 2020

Research Objective

The objectives of this is study were to evaluate the influence of Department of Veterans Affairs’ (VA) Full Practice Authority (FPA) policy change on Veterans’ access to primary health care (PHC).

Study Design

This was a nonexperimental quantitative study using secondary data from 139 VAMCs, from 2017 to 2019. Dependent variables were wait times in days for (a) new patient appointments; and (b) established patient appointments. Linear regression analyses with log transformations of continuous variables was used to complete the analysis. Independent variables for this study were the number of privileged PHC nurse practitioners (NPs) and time. Due to the number of VA Medical Centers (VAMCs) without privileged APRNs (50%), we created an indicator variable (0 = no privileged APRNs, 1 = all others). We conducted sensitivity analyses by using several model specifications for robustness checks and chose the models with the best fit. We controlled for possible confounding variables identified in previous research including the following: NP SOP laws, density of Veterans, APRNs, and physicians; and complexity levels and geographic locations of VAMCs.

Population Studied

As of March 2019, there were 140 VAMCs. This study included 26 months postimplementation data for 139 VAMCs (n = 3753). Puerto Rico was excluded due to lack of inclusion in the NP practice environment database.

Principal Findings

New patients waited on average for 7.79 days for a new appointment. The model with log transformations was a good predictor of new patient wait times [F (28, 3724) = 17.68, P < .001] and explained 12% of the variation. An increase of 10% in privileged PHC NPs at the facility level was associated with a decrease in new patients’ wait times by about 4% (P = .006), which was equivalent to a reduction of 0.30 days. Established patients waited on average for 4.34 days for a new appointment. However, there was no statistically significant relationship between facilities with privileged PHC NPs and established patients wait times compared with those facilities with no privileged PHC NPs (P = .545).

Conclusions

Our findings indicated decreases in new patient wait times were associated with improved utilization of existing PHC NP resources as PHC providers within VHA had not significantly changed. Results indicated significant strides in VA’s goal to improve utilization of existing PHC provider resources by permitting FPA. Our study did not find the number of privileged PHC NPs influenced established wait times. However, according to VHA policy, new PHC providers are afforded 12 to 15 months to build their panels which should only be 75% of physicians. VHA’s panel management policy may account for the difference found between new and established wait times.

Implications for Policy or Practice

Within VA, the largest integrated health care system in the United States, FPA has positively influenced access in new patient wait times to PHC. Opportunity exists to further improve access to PHC, in a budget neutral manner, by decreasing the gap between the number of privileged PHC NPs and available PHC NPs resources.