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Ky. APRN’s calling for more prescribing authority, KMA says not likely

Published: Jul. 26, 2021 at 6:02 PM EDT
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Ky. (WBKO) - WBKO News continues coverage on Bridging The Great Health Divide which features stories on healthcare discrepancies and claims in the Appalachia region.

Nurse practitioners are calling for more prescribing authority in order to fill the rural health care gaps in Kentucky, they say.

Meanwhile, the Kentucky Medical Association (KMA) says that change is unlikely any time soon.

As the number of doctors in rural Kentucky decrease, nurse practitioners are increasing. Data shows that the number of APRNs doubled in Metcalfe County between 2010 and 2019. That same data shows the county lost one of its doctors during that time period.

“We stay pretty busy,” said Angela Jessie, APRN at FH&L, LLC Family Practice in Edmonton.

However, APRNs have cited barriers in the state of Kentucky that they say make it difficult for them to practice at their “full scope.”

“The barrier of the Collaborative Practice Agreement is an agreement that a nurse practitioner has to have with a physician,” explained Jessie.

Rules for APRNs vary state by state. In Kentucky, a Collaborative Practice Agreement has to be in place between a physician and an APRN in order for the nurse to write prescriptions such as controlled substances.

“That restricts our ability to prescribe controlled substances and puts a huge barrier on those practitioners who are trying to work in a rural setting that can’t find a physician that is either willing to sign it, or they charge an enormous fee to sign it,” said Jessie.

Jessie, who runs a family practice in Edmonton as an APRN, finds that the collaborative agreement is not effective as one had to be in place in order for her to open her practice.

“That particular physician does not have to be here. He’s actually never been here. And he only has to be available if I have a question about prescribing,” said Jessie.

The agreement was lifted during the pandemic which expired last month, so the collaborative agreement is back in place. The Kentucky Medical Association says while office volumes were down during the pandemic, prescriptions by APRNs for controlled substances were up ‘significantly.’

“When we were in the real throngs of COVID, although my hospital hours increased voluminously, my office hours, almost shrank,” said Dr. Donald Swikert, Legislative Quick Action Committee with the Kentucky Medical Association. “So my prescribing probably should have decreased significantly.”

However, The National Council of State Boards of Nursing says this claim is unfounded and adds that an increase in opioid prescribing without that collaborative agreement “remained consistently lower than that of physicians.”

2019-2020 prescriptions
2019-2020 prescriptions(The National Council of State Boards of Nursing (NCSBN))

“The Kentucky Medical Association has fought against nurse practitioners having our full prescriptive authority,” claimed Jessie.

According to the Kentucky Medical Association, APRN prescribing of controlled substances increased up to 478% over the last ten years.

“If you’re going to get into the realm of high-risk medications, then there ought to be some oversight issues that go on,” said Swikert.

Kentucky All Schedule Prescription Electronic Reporting (KASPER) says APRN scripts were down 34 percent in 2020 compared to 2015.

Comparing opioid prescribing from 2015 vs 2020.
Comparing opioid prescribing from 2015 vs 2020.(e KY All Schedule Prescription Electronic Reporting)

“We’ll be back again in the next legislative session in hopes of getting that removed,” said Jessie.

The KMA and APRNs continue to go back and forth on data and the fate of the collaborative agreement-- something that might have legs in the 2022 session.

“Patient care benefits significantly when physicians and non-physicians work as a team,” expressed Swikert.

“If that collaborative practice was removed, it would open the door for nurse practitioners to open practices in rural settings where all of the needs are present, and fill that huge gap that is there,” said Jessie.

The Kentucky Coalition of Nurse Practitioners and Nurse-Midwives (KCNPNM) has provided a PDF that outlines their full report on APRN prescribing. That can be viewed below:

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