A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians’ Patterns of Practice and Quality of Care in Health Centers

Kurtzman, Ellen T.; Barnow, Burt S.

doi:10.1097/mlr.0000000000000689

Cited by 148 publications

(120 citation statements)

References 34 publications

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“…At the population level, nursing practice laws may improve the healthcare ecosystem available for the entire spectrum of injury sequelae, from health promotion and risk reduction of violence against self or others to emergency injury treatment and follow-up care that prevents injury mortality. Prior studies of nursing practice laws have found an effect on healthcare resources and patient outcomes as they relate to inpatient hospitalization and medical care [27,28]. Our study extends these findings by linking nursing practice laws to injury outcomes and suggesting that nurses are beneficial to population health outcomes more broadly than has been identified previously.…”

Section: Discussionsupporting

confidence: 78%

“…Scope-of-practice laws for NPs are a contentious policy issue in the US, with some states allowing independent practice for NPs without physician oversight and others requiring physician oversight for all APRN practice [26]. There is substantial evidence that increasing NP scope of practice is not only safe and effective, but also increases access to care for underserved populations [27][28][29]. For RNs, the key law affecting their practice is the Nurse Licensure Compact.…”

Section: Introductionmentioning

confidence: 99%

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The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016

Choi

Takada

Saadi

et al. 2020

BMC Health Serv Res

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Background: Nursing resources can have a protective effect on patient outcomes, but nurses and nursing scope of practice have not been studied in relation to injury outcomes. The purpose of this study was to examine whether scope of practice and ease of practice laws for nurse practitioners and registered nurses are associated with suicide and homicide rates in the United States. Methods: This state-level analysis used data from 2012 to 2016. The outcome variables were age-adjusted suicide and homicide rates. The predictor variables were NP scope of practice by state (limited, partial, or full) and RN ease of practice (state RN licensure compact membership status). Covariates were state sociodemographic, healthcare, and firearm/firearm policy context variables that have a known relationship with the outcomes. Results: Full scope of practice for NPs was associated with lower rates of suicide and homicide, with stronger associations for suicide. Likewise, greater ease of practice for RNs was associated with lower suicide and homicide rates.Conclusions: Findings suggest that nurses are an important component of the healthcare ecosystem as it relates to injury outcomes. Laws supporting full nursing practice may have a protective effect on population health in the area of injuries and future studies should explore this relationship further.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016

Choi

Takada

Saadi

et al. 2020

BMC Health Serv Res

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“…Both studies reported lower quality of HIV care by general medicine non‐HIV experts. Several other studies have reported delivery of non‐HIV–specific primary care by NPs and PAs that is at least comparable in quality to care provided by physicians . Our study was the first to examine physicians, nurse practitioners, and physician assistants providing HIV care at different types of facilities in both high‐ and low‐prevalence areas, representative of the diversity of U.S. HIV care providers.…”

Section: Discussionmentioning

confidence: 92%

Sustaining the HIV care provider workforce: Medical Monitoring Project HIV Provider Survey, 2013‐2014

Weiser

Chen

Beer

et al. 2019

Health Services Research

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Objective To describe delivery of recommended HIV care and work satisfaction among infectious disease (ID) physicians, non‐ID physicians, nurse practitioners (NPs), and physician assistants (PAs). Data Sources Medical Monitoring Project 2013‐2014 HIV Provider Survey. Study Design Population‐based complex sample survey. Data Collection/Analysis Methods We surveyed 2208 HIV care providers at 505 US HIV care facilities and computed weighted percentages of provider characteristics, stratified by provider type. Rao‐Scott chi‐square tests and logistic regression used to compare characteristics of ID physicians with each other provider type. Principal Findings The adjusted provider response rate was 64 percent. Among US HIV care providers, 45 percent were ID physicians, 35 percent non‐ID physicians, 15 percent NPs, and 5 percent PAs. Satisfaction with administrative burden was lowest among non‐ID physicians (27 percent). Compared with ID physicians, satisfaction with remuneration was lower among non‐ID physicians and higher among NPs (37, 28, and 51 percent, respectively). NPs were more likely than ID physicians to report performing four of six services that are key to providing comprehensive HIV care, but more NPs planned to leave clinical practice within 5 years (19 vs 7 percent). Conclusion Addressing physician dissatisfaction with remuneration and administrative burden could help prevent a provider shortage. Strengthening the role of NPs may help sustain a high‐quality workforce.

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“…Although PAs and NPs differ in their professional philosophies and training, the scope of services they deliver in healthcare settings is often equivalent. 15,34 To obtain robust estimates, PAs and NPs were combined into a singular provider type, consistent with research where the sample size is not large enough to report on each type of provider. 22,35 …”

Section: Methodsmentioning

confidence: 99%

Visits for Depression to Physician Assistants and Nurse Practitioners in the USA

Keller

Hooker

Jacobs

2017

J Behav Health Serv Res

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Depression is a prevalent condition in the US, and limited access to mental health providers is a significant national public health issue. Use of physician assistants (PA) and nurse practitioners (NP) to provide depression management could increase access to care for this important problem. Visits for depression to PAs and NPs in ambulatory care were examined using the 2005–2011 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. The seven-year data identified that approximately 7 billion visits for depression were evaluated by one of three medical providers (93.3% physician only, 2.9% PA/NP only, 3.9% combined). Overall, PA/NPs were involved in 42 million (6.7%) of depression visits. Some differences in sociodemographic and health characteristics of patients emerged by provider type. Compared to physicians, PA/NP only visits were more likely to be with patients that were from urban areas and patients with public insurance. Patients more likely to be seen by a physician were older and racial and ethnic minorities. Increased use of PAs and NPs may be an important strategy for improving access to depression care.

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A Comparison of Nurse Practitioners, Physician Assistants, and Primary Care Physicians’ Patterns of Practice and Quality of Care in Health Centers

Abstract: Across the outcomes studied, results suggest that NP and PA care were largely comparable to PCMD care in HCs.

Cited by 148 publications

References 34 publications

The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016

The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016

Sustaining the HIV care provider workforce: Medical Monitoring Project HIV Provider Survey, 2013‐2014

Visits for Depression to Physician Assistants and Nurse Practitioners in the USA

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