Primary health care faces significant workforce challenges, particularly in care for vulnerable populations and in underserved areas. The University of New Hampshire (UNH) Advanced Nursing Education Workforce (ANEW) program worked to increase the supply of primary care providers by developing innovative pathways to support registered nurses in becoming primary care nurse practitioners (NPs) with a participant commitment to serve a post- graduate period working in primary care in underserved areas. The ANEW program also used data from the NH Comprehensive Health Information System (NHCHIS), NH’s all-payer claims
database, to examine primary care provision in the state and identify primary care provider types and settings.
The benefits of primary care access for both individual and population health have been well documented. Access to primary care improves health care outcomes, lowers costs, and reduces health care disparities, yet primary care remains underfunded when compared to total health care costs. At the same time, primary care experiences significant workforce shortages at all levels, which have been exacerbated by the COVID-19 pandemic.
This issue brief outlines key findings and lessons learned from ANEW about the current supply and distribution of primary care providers in NH and how primary care supply can be augmented by supporting nurse practitioners, particularly those from rural or underserved
areas or populations, in completing a master’s level NP program and becoming licensed primary care providers.
Review of NH health professions and claims data showed that NPs have the highest number of providers practicing in rural communities; over the course of 2018-2021 percentage of total NP visits for Commercial, Medicaid, and Medicare increased in comparison to the percent of total visits for physicians, which decreased in the same time period.
In response to NH’s primary care provider shortages, the ANEW program, in conjunction with the UNH Department of Nursing and funded by HRSA, provided tuition support and training for registered nurses to become NPs and practice in NH’s rural and underserved primary care
settings. Over the grant period, ANEW supported training for 47 nurses to become primary care NPs and eight NPs to achieved post-master's psychiatric NP certification. With tuition assistance of $1,077,500, 100% of graduates from the 2019-2022 cohort chose to work ineither primary care, underserved, or rural settings. The ANEW program also coordinated
efforts to better understand NP workforce challenges through a Project ECHO® program and
established a Preceptor Committee to develop a better understanding of preceptor needs.
