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A randomly-drawn statewide sample of 891 consumers revealed overall support for the advanced practice nurse role to be greater than 75 percent. Seeking health care consumers' reactions to proposed alternatives is a crucial step in planning and implementing a program of health care reform that will meet current and future health needs.
An essential preliminary step in designing much-needed widespread health care reform is the research-based assessment of perceptions of and receptivity to change among health care consumers. The crescendoing health care costs in the United States combined with the widespread epidemic of inadequate access to health care have created an urgent demand for health care reform in the U.S. -- and specifically, in the state of Missouri. Only through better understanding of the consumer's perceptions of the current health care system and expectations for future health care delivery can policy makers and health care providers develop a health care program that will meet local and national health care needs in the decades ahead. This is an especially urgent consideration in view of the current expanding population and growing health care needs at a time of diminishing economic resources (Mitchell, Krueger, & Moody, 1990).
The overall aim of the study reported here was to describe Missouri residents' expectations and perceptions of health care. More specifically, this study was to describe and examine statewide public opinion about current satisfaction with health care and acceptance of the advanced practice nurse role. The research project represented a statewide extension of earlier research (Armer, 1993; Shoot-Armer, 1983) examining expectations and perceptions of health care in two midwestern communities. With government poised on the brink of perhaps monumental changes in the health care delivery system, such information is both timely and urgent.
Earlier studies in Missouri revealed strong support
for expanded nurse practitioner role
In a state ranked 48th out of 50 in terms of the health of its citizens (based on 22 health factors such as percent of population covered by health insurance and per capita health care payments) (Morgan, Morgan, & Quitno, 1993), the state of Missouri grapples with the politically sensitive issue of health care reform in an era of cost constraint. A prominent debate centers on the regulation of the advanced practice nurse role, a role shown to provide cost-effective, high quality primary care (Aiken & Salmon, 1994; Office of Technology Assessment, 1986; Ramsey, McKenzie, & Fish, 1982; Spitzer, 1984). Indeed, many studies estimate that 50 to 90 percent of care provided by primary care physicians could be provided by nurse practitioners (NPs) at a fraction of the cost. Further validation of consumer receptivity to the provision of care by NPs is a key step in designing a restructured health care delivery system that meets the expectations and needs of the consumer.
In 1979, Shoot-Armer (1983) completed an extension of social survey research by Aday, Andersen, and Anderson (1977), using a modification of an instrument used in thier national surveys of 1963, 1970, and 1976 in a selected midwestern community. The 1991 extension of this research with Boone County, Missouri, households described current consumer responses to the advanced practice nurse role (Armer, 1993). The majority of respondents in 1991 supported the expanded nursing role, as indicated by positive responses to selected advanced practice nursing activities such as management of follow-up treatment and chronic illness. Highly favorable responses (70 to 94 percent agreement/strong agreement) to three of the selected examples of advanced practice nursing activities were found. The least …