How Nurse Practitioners Can Put Health Disparities Work into Action

After a year of identifying and understanding how health disparities and social determinants of health are affecting patient outcomes, it’s time for the medical community to take action toward actually addressing public and population health, according to Sophia Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, immediate past president of the American Association of Nurse Practitioners.

Thomas, who recently finished out her tenure with AANP, said most nurse practitioners like herself have had their fingers on the pulse of social determinants of health issues for decades. Since she began nurse practitioner school nearly 25 years ago, Thomas said she saw the way social factors affected her patients’ abilities to achieve health and wellness. In fact, it was those trends that motivated her to pursue her nurse practitioner license.

“When I was helping people in ICU, they were critically ill. They had complications from easily preventable diseases,” Thomas told PatientEngagementHIT in an interview. “And so when I was working in the hospital, I saw that if we could prevent some of these diseases in the community, or help patients manage them better, they wouldn't end up where they were. And so I decided to become a nurse practitioner.”

Those social factors played themselves out most strikingly during the COVID-19 pandemic, during which Thomas presided as AANP president. It quickly became apparent that Black and Hispanic people were more liable to the virus, not only because of the comorbidities they had, but because of the systemic factors that dictated the jobs they worked and quality of care they accessed.

Per June 2021 figures, the COVID-19 mortality rate would be 10 percent lower for Black people if they’d been able to access the same hospitals as their White counterparts. In other words, disparities in hospital quality may have contributed to the stark disparities in COVID-19 death rates.

According to Thomas, it’s time to move beyond simply acknowledging these disparities. Uncovering unequal treatment access or outcomes does not actually close these gaps, she suggested, but rather policy and regulatory changes can.

“COVID has really just shined a light on the fact that we have these disparities, and now’s really the time to address something, and take action in this country to improve the health of these communities,” she asserted. “Because when we have healthier communities, overall, we'll have a healthier nation.”

And as Thomas both reflected on her tenure as AANP president and looked to the future, she emphasized the role that nurse practitioners must play in that.

Nurses have extremely unique relationships with patients, and the nurse practitioner role amplifies that, Thomas said. Nurses get more face time with patients, building more intimate relationships that put nurses in a position to uncover certain social determinants of health that could make that patient another statistic in health disparities work.

“We do have unique relationships with our patients,” Thomas stated. “When you ask somebody why they'd go into nursing, they definitely don't do it for money. They say they want to do it because they want to help people. And to be a nurse practitioner is really an extension of that.”

In the primary care space, for example, Thomas said nurse practitioners are known for their focus on prevention rather than intervention. And when a patient does develop a full chronic disease, the nurse practitioner profession dictates an emphasis on holistic patient care.

“We really take time to educate the patients ourselves, to be sure they understand their disease, and the diagnosis, and what complications they can be,” she explained. “We make sure that they're able to pay for their own medication, we make sure that their medication regimen is something that they're able to follow. Do they have family support at home?”

“We know that people's ZIP code is very much a greater indicator of healthcare outcomes than their genetics,” Thomas continued. “And so, we look at the social factors that impact their ability to care for themselves. Do they have access to healthy food? Do they have transportation to get to their medicine, or to get to any specialist appointments? Is their house safe with them?”

What’s more, nurse practitioners are poised to help improve patient care access gaps, Thomas said. This will be crucial in rural areas where there are already documented primary care provider shortages, as well as in urban areas where patient trust is low and access complicated.

“Nurse practitioners really do offer healthcare choice and access to patients,” Thomas asserted.

Currently, there are more than 325,000 nurse practitioners performing more than a billion patient visits annually. According to Thomas, nurse practitioners treat more than 80 million people living in federally designated Health Professional Shortage Areas (HPSAs).

These nurse practitioners are filling in physician access gaps that are only slated to get steeper, she added, especially in the primary care space where so much care coordination and chronic disease prevention happens.

“Physicians aren't going into primary care anymore. They're really opting to go into more lucrative specialties or retiring,” Thomas said. “And so nurse practitioners are already living in many of these communities. They're going back to school and getting their education, and then they're staying in these communities to be primary care providers and meet the needs of those patients.”

According to data from the Primary Care Collaborative, the US can expect a primary care physician shortage of anywhere from 21,400 to 55,200 by 2033.

Granting full practice authority for nurse practitioners—a notorious point of contention for the advanced practice provider community and the physician community—would be a key step toward filling this gap, Thomas offered.

“We need to support our healthcare system, support our healthcare providers, and simplify the processes, and certainly removing all barriers to care, whether it's the actual providing of care, or barriers for patients receiving care,” she said.

Currently, 24 states, the District of Columbia, the Indian Health Service (IHS), US territories, and the VA health system offers nurse practitioners full practice authority. That means nurse practitioners providing care in those states or systems can work independently without having a written agreement with a physician.

“In the other states, nurse practitioners are restricted in their ability to practice and provide care, due to outdated regulatory burdens,” Thomas explained. “We need to modernize our healthcare system in that respect as well.”

This should come as part of a broad overhaul for the healthcare space, one that focuses mostly on holistic patient care and public health. Nurse practitioners are instrumental in identifying and addressing the social determinants of health, Thomas stated, and coupling the expansion of their practice with more concerted community health efforts will help revolutionize medicine to meet the moment.

“This is a time where we can really reimagine, or re-envision healthcare. Community healthcare is going to be revived, and public health. Back in the 1960s, public health was the focus. And we had the health units that were really active, and it was the focus on public and community health. And we've kind of lost that,” Thomas concluded.

“Right now we're going to refocus and reimagine what public health means, not only to prevent the next pandemic, but to focus on the health of the community, health of individuals, and charting new paths forward.”