Over a quarter of all Americans are not up to date with their health screenings and shots, according to a new American Association of Nurse Practitioners (AANP) survey.

“The first step toward a healthier America is to ensure that every patient can access the recommended health checks, evidence-based screenings, and immunizations they need,” Stephen A. Ferrara, DNP, president of AANP, said in a press release.

Adopting policies that remove barriers to care and ensure all patients can access the preventive screenings and health services they need is essential to improving the health of the nation.

The poll found that 27% of Americans were behind on regular health checkups, like screenings and shots, which Ferrara said “underscores the ongoing crisis of access to primary health care, which cuts across many communities.”

“The survey also highlights the broad public support for legislative proposals that would improve patient access and choice in health care,” he continued.

According to Harvard T.H. Chan School of Public Health, 100 million people in the U.S. don’t have a primary care provider.

The AANP survey found nearly 40% of Americans travel more than 10 miles to access care.

Ferrara said nurse practitioners can help with the shortage, but only 27 states allow nurse practitioners to be primary care providers.

“We still have a lot of work to do to convey to patients that nurse practitioners are providers who have the ability to prescribe medications, order diagnostic tests, order screenings, and are educated at the master’s and doctoral levels.”

The poll also found that 73% of adults support legislation for nurse practitioners to serve as their primary care providers.

“Patients continue to want greater access to the 385,000 licensed NPs who undergo demanding graduate-level education and clinical training,” Ferrara explained. “Patients are already choosing NPs, as proven by more than one billion patient visits annually. We urge lawmakers to enact legislation that removes restrictions on NP-delivered health care.”

Telehealth has been a game changer for the health system. It is significant for patients who live far away from health care facilities. The survey found 31% of Americans turned to telehealth or to convenient care clinics at pharmacies or other retailers for primary care.