AETC Education for Nurse Practitioners and Physician Assistants

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This funding opportunity announcement (FOA) solicits applications for the AIDS Education and Training Centers (AETC) Education for Nurse Practitioners (NP) and Physician Assistants (PA) program.  The intention of this funding opportunity is to establish nurse practitioner and physician assistant HIV/AIDS primary care education programs designed to train nurse practitioners and physician assistants in HIV/AIDS care and treatment.  Several important changes in the U.S. population will both increase future demand for health care and affect the adequacy of the future health care workforce to meet that demand.  These demographic changes include:  (1) growth in the general population, (2) increases in the racial/ethnic diversity of the population, (3) changes in the age distribution of the population through the aging of the ‘baby boomer’ generation, and (4) changes in the gender distribution of health care providers (Dill and Salsburg 2008; Salsberg and Grover 2006; Smalarz et al. 2007; Center for Workforce Studies 2005) The greatest growth in demand for  nurse practitioners and physician assistants has been in primary care.  The demand for nurse practitioners and physician assistants is likely to continue to increase as clinical tasks are shifted from physicians to nurse practitioners and physician assistants.. The number of nurse practitioners and physician assistants is likely to grow in future years (Mathematica Policy Research, 2009)  It is critically important that nurse practitioner and physician assistant students have the means and opportunity to receive HIV/AIDS training in order to graduate ready to provide HIV/AIDS primary care.   There are several studies which suggest that the quality of HIV-related primary care provided by nurse practitioners and physician assistants is similar to that provided by physicians. One study (Wilson et al. 2005) suggested that, under appropriate conditions, nurse practitioners and physician assistants who focus on HIV care and have high HIV caseloads can function as lead HIV clinicians and provide care equal to or better than care provided by physicians. NOTE:  Physician assistants always work in conjunction with and are supervised by a physician.   Combined with the salary differential and shorter period of education and training for  clinicians such as nurse practitioners and physician assistants, increasing their role in the delivery of health care services has the potential to reduce both physician workloads and costs without sacrificing outcomes. Nurse practitioners and physician assistants will be needed to fill gaps in geographic areas that experience difficulty recruiting and retaining physicians, such as rural areas and inner-city clinics serving predominantly underinsured and uninsured patient populations. Additionally, health care workforce analyses project inadequate numbers of primary care providers to satisfy the nation’s need for services. Between 2006 and 2025, the demand for physicians is projected to rise by 8%, from 228 to 246 physicians per 100,000 people, and the supply is projected to decline by 8%, from 228 to 210 full time physician equivalents per 100,000 people (Dall,Salsberg. “The Complexities of Physican Supply and Demand.” Association of American Medical Colleges:  Center for Workforce Studies. November 2008; 25-26). The purpose of this FOA, which ties directly to the shortage of primary health care providers in HIV/AIDS care in the U.S., is to fund accredited schools/programs to train  faculty  that teach HIV/AIDS and primary care services for patients with HIV/AIDS to nurse practitioner and physician assistant students.   Section 2692 (42 U.S.C. §300ff-111, 1-B) of the Public Health Service Act gives the authority for this funding opportunity.  The funds will support developmental work toward expanding existing accredited primary care nurse practitioner and physician assistant programs to include HIV courses in the curriculum.  Nurse practitioner students may be from accredited family, women’s health/GYN, certified nurse midwife, psychiatric/mental health or adult-geriatric nurse practitioner programs.  Physician assistant students must be from an academically affiliated physician assistant education program that is accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Note:  Since the 1960s, academic institutions have offered PA education that has focused on primary care.  While evidence shows that PAs are improving the geographic distribution of the health care workforce, there is also a steady trend toward care in urban settings (Henry, Hooker, Yates.  “The role of physician assistants in rural health care:  a systematic review of the literature”.  J Rural Health. 2011.  Spring.  27 (2):  220-229).  Reversal of this trend is complicated by the lack of a sufficient number of primary care and community based educators to train the next generation of PA students.  A Physician Assistant Education Association (PAEA) 2006 survey identified limited clinical training sites (49.4% of respondents) and limited preceptors (48.7% of respondents) as the primary barriers to expansion of PA programs (Glicken, Lane:  “Results of the PAEA 2006 Survey of PA Program Expansion Plans”.Journal of Physician Assistant Education.  18:1; 52-53). Funding preference will be given to applicants/organizations who request this and explain the basis for it as designated by Section 2692 (42 U.S.C. §300ff-111) of the Public Health Service Act.  As amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009, in making grants under paragraph (1), the Secretary shall give preference to qualified projects which will – (A)       train, or result in the training of, health professionals who will provide treatment for minority individuals and Native Americans with HIV/AIDS and other individuals who are at high risk of contracting such disease; (B)        train, or result in the training of, minority health professionals and minority allied health professionals to provide treatment for individuals with such disease; and (C)        train, or result in the training of, health professionals and allied health professionals to provide treatment for hepatitis B or C co-infected individuals. With the development of antiretroviral therapies, HIV has become a chronic disease. There is a great demand and need for primary care providers with HIV-treatment expertise within outpatient settings, e.g., AIDS-service organizations (ASOs), university based clinics, health departments, etc., to deliver a broad range of services. Nurse practitioners (NPs) and physician assistants (PAs) are now two of the principal groups of clinicians delivering primary health care in these settings. Consequently, this FOA targets workforce development of culturally competent primary care HIV nurse practitioners and physician assistants. Sustainability The primary goal of this funding opportunity is to expand the number of culturally competent nurse practitioners and physician assistants with capacity/capabilities to provide primary care to individuals living with HIV/AIDS.  A subset of this goal is the development of training curricula with an expectation that developed curricula will be evaluated and successful strategies will be shared with other nurse practitioner or physician assistant programs. Applicants are encouraged, but not required to partner with Ryan White Part C and/or Part D programs and/or Federal Training Center programs (PTCs, ATTCs, etc.) that have in-place signed agreements for training interns, in order to maximize training resources and opportunities and to increase the quality and success of the proposed project. Applicants are also encouraged to partner with their regional AETC to assist with these connections.  Applicants that choose to partner must provide a memorandum of understanding (MOU) or letter of agreement for each partner (Attachment 4). Appli

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