Nurse Practitioners and Physician Assistants in Primary Care

Atwater, Alison; Bednar, Susan; Hassman, Deborah; Khouri, Jodi

doi:10.1016/j.disamonth.2008.08.002

Cited by 14 publications

(11 citation statements)

References 9 publications

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“…As a secondary analysis, we also evaluated results by APC visit subtype (for example, APCs seeing the patient alone vs. alongside the physician) and profession subtype (for example, nurse practitioner vs. physician assistant) and compared them with results from physicians seeing patients without an APC, who made up the reference group (Appendix). Although training of nurse practitioners and physician assistants, as well as the regulatory environment in which they practice, differs between these groups and among the states in which they practice, we chose a combined APC variable, because both types of clinicians often play similar roles in the primary care setting (25) and because it made interpretation easier. In addition, the findings of the subgroup categories described earlier largely were consistent with our overall results.…”

Section: Methodsmentioning

confidence: 99%

Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians

Mafi¹,

Wee²,

Davis³

et al. 2016

Ann Intern Med

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Background Many physicians believe that advanced practice clinicians (APCs [nurse practitioners and physician assistants]) provide care of relatively lower value. Objective To compare use of low-value services among U.S. APCs and physicians. Design Service use after primary care visits was evaluated for 3 conditions after adjustment for patient and provider characteristics and year. Patients with guideline-based red flags were excluded and analyses stratified by office-versus hospital-based visits, acute versus nonacute presentations, and whether clinicians self-identified as the patient’s primary care provider (PCP). Setting National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS), 1997 to 2011. Patients Patients presenting with upper respiratory infections (URIs), back pain, or headache. Measurements Use of guideline-discordant antibiotics (for URIs), radiography (for URIs and back pain), computed tomography (CT) or magnetic resonance imaging (MRI) (for headache and back pain), and referrals to other physicians (for all 3 conditions). Results 12 170 physician and 473 APC office-based visits and 13 359 physician and 2947 APC hospital-based visits were identified. Although office-based clinicians saw similar patients, hospital-based APCs saw younger patients (mean age, 42.6 vs. 45.0 years; P < 0.001), and practiced in urban settings less frequently (49.7% vs. 81.7% of visits; P < 0.001) than hospital-based physicians. Unadjusted and adjusted results revealed that APCs ordered antibiotics, CT or MRI, radiography, and referrals as often as physicians in both settings. Stratification suggested that self-identified PCP APCs ordered more services than PCP physicians in the hospital-based setting. Limitation NHAMCS reflects hospital-based APC care; NAMCS samples physician practices and likely underrepresents office-based APCs. Conclusion APCs and physicians provided an equivalent amount of low-value health services, dispelling physicians’ perceptions that APCs provide lower-value care than physicians for these common conditions. Primary Funding Source U.S. Health Services and Research Administration, Ryoichi Sasakawa Fellowship Fund, and National Institutes of Health.

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Section: Methodsmentioning

confidence: 99%

Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians

Mafi¹,

Wee²,

Davis³

et al. 2016

Ann Intern Med

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“…PAs and NPs come from different educational backgrounds, but they function similarly in the clinical setting to increase access to and efficiency of health care while maintaining the quality of care. 83 For the last 10 years, there has been a stable undersupply of dermatologic services in the United States as a result of increased demand for services and limited training positions for new doctors. 84 Increased demand for dermatology services is driven in part by the aging population and accompanying increase in skin diseases such as AK.…”

Section: Nonphysician Clinicians In Dermatologymentioning

confidence: 99%

Current issues in the management of actinic keratosis

Ceilley

Jorizzo

2013

Journal of the American Academy of Dermatology

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“…[31][32][33] It is important to consider that MLPs have been successfully utilized in primary care settings for decades. 34 However, in primary care, the MLP and physician supervisor work closely on a daily basis, thereby establishing the appropriate level of autonomy to be granted. This does not reflect the complexity of ED staffing.…”

Section: Discussionmentioning

confidence: 99%

Trends in Midlevel Provider Utilization in Emergency Departments from 1997 to 2006

Menchine

Wiechmann

Rudkin

2009

Academic Emergency Medicine

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Objectives: The objective was to quantify the expansion of midlevel provider (MLP) practice in U.S. emergency departments (EDs) over the past decade. Specifically, we sought to quantify the absolute number of patients seen by MLPs, the annual growth rate of patients seen by MLPs, and the expansion in the proportion of EDs using MLPs.Methods: Data were analyzed from the ED portion of the 10 most recent years (1997 to 2006) National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative survey of ED visits compiled by the Centers for Disease Control and Prevention (CDC). The main outcomes of interest were the proportion and absolute numbers of ED patients seen by MLPs during the 10-year study period. National estimates derived from sample weights are reported. In addition, a multivariate logistic regression model was created with ''seen by midlevel provider'' as the dependent variable to determine factors associated with being seen by a MLP.

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Nurse Practitioners and Physician Assistants in Primary Care

Cited by 14 publications

References 9 publications

Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians

Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians

Current issues in the management of actinic keratosis

Trends in Midlevel Provider Utilization in Emergency Departments from 1997 to 2006

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