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Evidence-Based Oncology January 2017
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Incorporating Nurse Specialists Into Hematology Care: Improved QOL for Patient and Provider

Surabhi Dangi-Garimella, PhD
During the ASH Practice Partnership lunch, Joseph Alvarnas, MD, from the City of Hope, and editor-in-chief of Evidence-Based Oncology™ moderated a panel discussion on the impact of including nurse practitioners, physician assistants, and clinical nurse specialists into hematology care.
ON THE SECOND DAY of the 58th Annual Meeting & Exposition of the American Society of Hematology (ASH), Joseph Alvarnas, MD, chaired the ASH Practice Partnership lunch. Alvarnas, director of Value-Based Analytics and director of Clinical Quality for the Alpha Clinic for Cell Therapy and Innovation, City of Hope, Duarte, California, also serves as editor-in-chief of Evidence-Based Oncology™. The topic of discussion was the impact of including nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs) into hematology care.

As the care delivery model continues to evolve, the roles of NPs, PAs, and other CNSs who care for patients with hematologic diseases is growing. Although some practices work to ensure that these professionals come together as a team, many can be more efficient. For this particular session, Alvarnas was joined by Marc Zumberg, MD, professor of medicine and section chief, Benign Hematology, University of Florida, Gainesville, Florida; Clayton Hunter, PA-C, physician assistant, University of Florida, Gainesville, Florida; H. Jean Khoury, MD, professor and director, Division of Hematology, Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, Georgia; and Brittany Hill, PA-C, MMSc, MSc, MPH, physician assistant, Department of Hematology and Medical Oncology, Winship Cancer Institute.

Zumberg shared best practices at their clinic at the University of Florida. “PA training is very exhaustive and rigorous, similar to an MD degree,” he told the audience. “They have to maintain [continuing medical education] credits throughout their career. APRNs, or advanced practice registered nurses, [also] may have specializations, but they spend as much time as MDs, in the clinic,” Zumberg said. APs can improve patient access, support physicians in the clinic, and help physicians achieve a better work-life balance, according to Zumberg.

“APs have prescribing privileges, and they can conduct patient visits. However, there could be some statewide differences,” he said. Zumberg described 3 different models that can be used in practice:
  1. Independent model, where the AP sees patients independently
  2. Shared-visit model, where the patient is seen together with the physician
  3. Mixed-visit model, which is a combination of the above
“A 50% increase in demand for oncologists is expected by 2020, but the number of oncologists is decreasing,” Zumberg said. This is further complicated by the fact that there’s been an 81% increase in survivors and those newly diagnosed with cancer, which demands a boost in the workforce.

Zumberg then shared the results of a study1 initiated by the American Society of Clinical Oncology to conduct a national survey of integrating nonphysician practitioners (NPPs) and identifying collaborative practice models and services provided by NPPs. The study concluded that NPPs in oncology practices increase productivity for the practice and provide high physician and NPP satisfaction. Ninety-eight percent of patients were aware when care was provided by an NPP, and 92% reported being very satisfied with all aspects of the collaborative care that they received.

“I think incorporating APs is beneficial to the practice. It im proves access to care, improves care continuity, and APs have a more holistic approach to patient care,” Zumberg said, adding that physicians can benefit as well since they can now include more patients in the practice and reserve their time for the more complex patients. “Additionally, APs can improve the quality of life and work-life balance for MDs” he added.



 
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