Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care

Hannah T. Neprash, Laura Barrie Smith, Bethany Sheridan, Ira Moscovice, Shailendra Prasad, Katy Kozhimannil

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


The growing ranks of nurse practitioners (NPs) in rural areas of the United States have the potential to help alleviate existing primary care shortages. This study uses a nationwide source of claims- and EHR-data from 2017 to construct measures of NP clinical autonomy and complexity of care. Comparisons between rural and urban primary care practices reveal greater clinical autonomy for rural NPs, who were more likely to have an independent patient panel, to practice with less physician supervision, and to prescribe Schedule II controlled substances. In contrast, rural and urban NPs provided care of similar complexity. These findings provide the first claims- and EHR-based evidence for the commonly held perception that NPs practice more autonomously in rural areas than in urban areas.

Original languageEnglish (US)
Pages (from-to)684-692
Number of pages9
JournalMedical Care Research and Review
Issue number6
Early online dateJul 29 2020
StatePublished - Dec 2021

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the FORHP, HRSA, U.S. Department of HHS (Grant No. 5U1CRH03717) and the Robert Wood Johnson Foundation (Grant No. 41978).

Publisher Copyright:
© The Author(s) 2020.


  • nurse practitioners
  • primary care
  • rural health care
  • scope of practice

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.


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