Policy analysis of Texas Senate Bill 532 and the regulation of nurse practitioners in the convenience care model

Background. Retail clinics, also called convenience care clinics, have become a rapidly growing trend since their initial development in 2000. These clinics are coupled within a larger retail operation and are generally located in "big-box" discount stores such as Wal-mart or Target, grocery stores such as Publix or H-E-B, or in retail pharmacies such as CVS or Walgreen's (Deloitte Center for Health Solutions, 2008). Care is typically provided by nurse practitioners. Research indicates that this new health care delivery system reduces cost, raises quality, and provides a means of access to the uninsured population (e.g., Deloitte Center for Health Solutions, 2008; Convenient Care Association, 2008a, 2008b, 2008c; Hansen-Turton, Miller, Nash, Ryan, Counts, 2007; Salinsky, 2009; Scott, 2006; Ahmed & Fincham, 2010). Some healthcare analysts even suggest that retail clinics offer a feasible solution to the shortage of primary care physicians facing the nation (AHRQ Health Care Innovations Exchange, 2010). ^ The development and performance of retail clinics is heavily dependent upon individual state policies regulating NPs. Texas currently has one of the most highly regulated practice environments for NPs (Stout & Elton, 2007; Hammonds, 2008). In September 2009, Texas passed Senate Bill 532 addressing the scope of practice of nurse practitioners in the convenience care model. In comparison to other states, this law still heavily regulates nurse practitioners. However, little research has been conducted to evaluate the impact of state laws regulating nurse practitioners on the development and performance of retail clinics. ^ Objectives. (1). To describe the potential impact that SB 532 has on retail clinic performance. (2). To discuss the effectiveness, efficiency, and equity of the convenience care model. (3). To describe possible alternatives to Texas' nurse practitioner scope of practice guidelines as delineated in Texas Senate Bill 532. (4). To describe the type of nurse practitioner state regulation (i.e. independent, light, moderate, or heavy) that best promotes the convenience care model. ^ Methods. State regulations governing nurse practitioners can be characterized as independent, light, moderate, and heavy. Four state NP regulatory types and retail clinic performance were compared and contrasted to that of Texas regulations using Dunn and Aday's theoretical models for conducting policy analysis and evaluating healthcare systems. Criteria for measurement included effectiveness, efficiency, and equity. Comparison states were Arizona (Independent), Minnesota (Light), Massachusetts (Moderate), and Florida (Heavy). ^ Results. A comparative states analysis of Texas SB 532 and alternative NP scope of practice guidelines among the four states: Arizona, Florida, Massachusetts, and Minnesota, indicated that SB 532 has minimal potential to affect the shortage of primary care providers in the state. Although SB 532 may increase the number of NPs a physician may supervise, NPs are still heavily restricted in their scope of practice and limited in their ability to act as primary care providers. Arizona's example of independent NP practice provided the best alternative to affect the shortage of PCPs in Texas as evidenced by a lower uninsured rate and less ED visits per 1,000 population. A survey of comparison states suggests that retail clinics thrive in states that more heavily restrict NP scope of practice as opposed to those that are more permissive, with the exception of Arizona. An analysis of effectiveness, efficiency, and equity of the convenience care model indicates that retail clinics perform well in the areas of effectiveness and efficiency; but, fall short in the area of equity. ^ Conclusion. Texas Senate 532 represents an incremental step towards addressing the problem of a shortage of PCPs in the state. A comparative policy analysis of the other four states with varying degrees of NP scope of practice indicate that a more aggressive policy allowing for independent NP practice will be needed to achieve positive changes in health outcomes. Retail clinics pose a temporary solution to the shortage of PCPs and will need to expand their locations to poorer regions and incorporate some chronic care to obtain measurable health outcomes. ^

A geographic information science (GIS) approach to conducting comparative area-level community assessments in the Texas CORD Study

This study assessed and compared sociodemographic and income characteristics along with food and physical activity assets (i.e. grocery stores, fast food restaurants, and park areas) in the Texas Childhood Obesity Research Demonstration (CORD) Study intervention and comparison catchment areas in Houston and Austin, Texas. The Texas CORD Study used a quasi-experimental study design, so it is necessary to establish the interval validity of the study characteristics by confirming that the intervention and comparison catchment areas are statistically comparable. In this ecological study, ArcGIS and Esri Business Analyst were used to spatially relate U.S. Census Bureau and other business listing data to the specific school attendance zones within the catchment areas. T-tests were used to compare percentages of sociodemographic and income characteristics and densities of food and physical activity assets between the intervention and comparison catchment areas.^ Only five variables were found to have significant differences between the intervention and comparison catchment areas: Age groups 0-4 and 35-64, the percentage of owner-occupied and renter-occupied households, and the percentage of Asian and Pacific Islander residents. All other variables showed no significant differences between the two groups. This study shows that the methodology used to select intervention and comparison catchment areas for the Texas CORD Study was effective and can be used in future studies. The results of this study can be used in future Texas CORD studies to confirm the comparability of the intervention and comparison catchment areas. In addition, this study demonstrates a methodology for describing detailed characteristics about a geographic area that practitioners, researchers, and educators can use.^

Description and analysis of variation in dairy product and concomitant nutrient purchases between Hispanic and non -Hispanic households using a panel of shoppers' purchase records

The purpose of this research was development of a method of estimating nutrient availability in populations as approximated by supermarket purchase records. Demographic information describing 12,516 panel households was obtained from a marketing and advertising program operated by H. E. Butt Grocery Company of San Antonio, Texas. A non-probability sample of 2,161 households meeting expenditure criteria was selected and all purchases of dairy products for this sample of households were organized into a database constructed to facilitate the retrieval, aggregation, and analysis of dairy product purchases and their nutrient contents. Two hypotheses were tested: (1) no difference would be found between Hispanic and non-Hispanic purchases of dairy product categories during the study period and (2) no difference would be found between Hispanic and non-Hispanic purchases of nutrients contained in those dairy products during the thirteen-week study period.^ Food purchase records were used to estimate nutrient exposure on a weekly, per capita basis for Hispanic and non-Hispanic households by linking some 40,000 dairy purchase Universal Product code (UPC) numbers with food composition values contained in USDA Handbook 8-1. Results of this study suggest Hispanic sample households consistently purchased fewer dairy products than did non-Hispanic sample households and consequently had fewer nutrients available from dairy purchases. While weekly expenditures for dairy products among the sample households remained relatively constant during the study period, shifts in the types of dairy products purchased were observed. The effect of ethnicity on dairy product and nutrient purchases was significant over the thirteen-week period. A database consisting of customer, household, and purchase information can be developed to successfully associate food item UPC numbers with a standard reference of food composition to estimate nutrient availability in a population over extended periods of time. ^

Account books of Sylvester Woodbridge, 1792-1826 (inclusive)

Consists of seven account books kept by Dr. Sylvester Woodbridge (1754-1824) from 1792 until his death containing entries that record charges for medical visits and administration of medicines, and sales of sundry and grocery items, as well as occasional personal notes and the names of Woodbridge's apprentices and their participation in his Southampton, Massachusetts, medical practice. Woodbridge's methods of treatment were typical for the era: he most commonly prescribed vomits and purgatives for patients. Volume 6 contains loose pages and letterbooks tucked in related to accounting and to the amount and type of wood Woodbridge was buying for his house, and papers dated after his death.

Left: Livery & Sale Stables, J.A. Polhemus & Son, Proprs., Ann Arbor, Mich. Left: Buchoz's Block, Ann Arbor, Mich. Bottom: Orchestrian Hall, Fred Rettich, Proprietor, Ann Arbor, Mich.

Ann Arbor, Mich. businesses. Publication information: Chicago, Ill. : Everts & Stewart, 1874.

Main St. looking south from Fifth St. to Fourth St.

verso: This picture was taken of Hancock (Main) street before 1888 looking south from Fifth St. to Fourth St and the buildings on the right are Weidensees Saloon, Bunyeas Grocery, Birds Store, Schmidts saloon, Haugheys store, Moodys poolroom Next unknown, Dreves poolroom, Rices jewelry Store and Finchers drugs. That takes in the whole block. On the left hand, I was not so successful. First is Kuhns saloon, No 4 is Gardners genl store, 5 unknown, six Tuttles bakery and 7 the Post-office over which I was born in 1882.

Studies in the packing industry /

[no. 1] The chain store and the packing industry, by E. L. Rhoades.--[no. 2] The management of chain meat markets, by E. L. Rhoades.--[no. 3] Chain stores and the independent meat retailer, by E. L. Rhoades.--[no. 4] Advertising of meats by chain grocery companies, by E. L. Rhoades.--[no. 5] Consumption of meat and meat products, with particular reference fo price, by J. H. Cover.

Household engineering : scientific management in the home /

Includes samples of menus, suggestions for planning meals, grocery shopping, ways of saving time and money, description of household appliances, etc.

The complete economical cook and frugal housewife : an entirely new system of domestic cookery : containing approved directions for purchasing, preserving, and cooking : also, trussing and carving, preparing soups, gravies, sauces, made dishes, potting, pickling, &c. : with directions for pastry and confectionery : likewise the art of making British wines, brewing, baking, &c. /

"Bills of fare": p. 63-90; "Table of income and wages": p. 426; "Marketing tables": p. [427]-432.

"Aunt Babette's" cook book : foreign and domestic receipts for the household : a valuable collection of receipts and hints for the housewife, many of which are not to be found elsewhere /

Includes sections on servants, grocery marketing, canning; household hints; samples of menus; recipes for German, French, Hungarian, Italian, Polish, Russian, Jewish dishes; some recipes include wine or liquor as an ingredient. Sample recipes: Filet de bœuf au champignons, Velvet potato puffs, Rhubarb custard pie, Bergamot ice-cream.

Feeding four on a dollar a day; a Denver family experiment in feeding adequate food to a family of four on a dollar a day for a month, with tested menus and prized recipes,

First issued under title: A Denver family experiment in feeding adequate food to a family of four on a dollar a day.

Operating results of Indiana wholesale grocers year of 1927.

Mimeographed.

Food purchasing for the home,

Includes bibliographical references and index.

Behind the scenes of business,

Mode of access: Internet.