The role the Affordable Care Act (ACA) play in addressing workforce shortages in rural communities

 

 

 

How should nurses assure policy change for advanced practice registered nurses?” What role does the Affordable Care Act (ACA) play in addressing workforce shortages in rural communities?

Sample Solution

Advanced practice registered nurses (APRNs) are a key part of the workforce in providing healthcare to rural communities and assuring policy change is necessary to ensure they are adequately utilized. The Affordable Care Act (ACA) has further enabled APRN’s involvement in addressing shortages by removing barriers that were previously restricting them from full practice authority and expanded reimbursement opportunities for services rendered (American College of Nurse-Midwives, 2017). The ACA also facilitates increased access to evidence based care through development of nurse managed health centers that provide comprehensive primary care, including chronic disease management and mental health services (U.S. Department of Health & Human Services, 2019).

In order to assure policy change for advanced practice registered nurses, it is important for nurses to become actively involved in supporting legislative efforts that expand their roles, as well as advocating on behalf of those living in rural areas who may have limited access to care due to workforce shortages. Nurse leaders must also educate policymakers on the value APRNs bring when integrated into interdisciplinary teams so their contributions are recognized and compensation is commensurate with other members of the team (Roper et al., 2017). Additionally, the use of telehealth can help bridge gaps between remote communities and providers located elsewhere allowing more timely access to specialized care which can improve patient outcomes while reducing costs associated with travel or duplication of treatments (Hanson et al., 2016).

The implementation of these measures can assist in expanding roles for APRNs while helping address workforce shortages in rural communities as specified by the ACA. In doing so, patients will benefit from improved access thus leading toward better health outcomes.

The basic aim of the personalized medicine is applying right therapy to the right population of people by defining disease at the moecular level. So, identifying differences among the individuals support the new treatment methods and pharmaceutical companies to develop new cancer drugs. Patients who have similar clinical outcome and histological tumor type can give different response to the same drug(17). Prediction of who will be a nonresponders reduces the harmfull effect of drug on nonresponders like a potential toxic effect of drug and cost effect. Also when drug companies develop new drug, they focus on the patient population that benefit from drug to increase positive responds(17).

U.S. Food and Drug Administration bringed development about targeted therapy. For example, to treat chronic myeloid leukemia and gastrointestinal stromal tumor(18) ,imatinib mesylate is used and to treat breast cancer(19), trastuzumab (Herceptin) is used. Molecular characteristics of these cancer types that are abnormal protein tyrosine kinase activity in chronic myeloid leukemia and gastrointestinal stromal tumor and HER-2 receptor in breastcancer is used as a predictive biomarker. By using these markers only individuals which have these molecular alteration is selected and it means they are favorable for the treatment. Using this way some cancer types’ survival rate is shifted from 0 to 70%(17).

This application is used in non-small cell lung cancer treatment with using of mutations screeing. In this cancer type mutation occurs in kinase domain of EGFR. Gefitinib (Iressa) and erlotinib are tyrosine kinase inhibitors drug are used to treat and patients give a higher response to the treatment(20). Also if patient that is never smoked Asian females have adenocarcinomas, these drugs efficient on them(21). On the other hand, if the mutatuions occur at downstream effector KRAS, patient is resistant to to erlotinib(22). Also mutations that is at KRAS have a resistance to cetuximab (Erbitux) and panitumumab (Vectibix) drugs in colon cancer patients. If the KRAS is wild type, these these drugs is effective on the patients(23). These responses that are specific and different are based on molecular profile. Some molecular test are done before the using of cetuximab or panitu

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