Background
A recent workforce study of rheumatology in the US suggests that during the next several decades the demand for rheumatology services will outstrip the supply of rheumatologists. Mid-level providers such as nurse practitioners (NPs) and physician assistants (PAs) may be able to alleviate projected shortages.
Methods
We administered a nation-wide survey of mid-level providers during 2012. Invitations with the survey were sent with one follow-up reminder. The survey contained questions regarding demographics, training, level of practice independence, responsibilities, drug prescribing, use of objective outcome measures, and knowledge and use of treat to target (TTT) strategies.
Results
The invitation was sent to 482 eligible mid-level providers via e-mail and 90 via US mail. We received a total of 174 (30%) responses. The mean age was 46 years and 83% were female. Nearly 75% had ≤10 years of experience, 53% had received formal training in rheumatology. Almost two-thirds reported having their own panel of patients. The top three practice responsibilities described were performing patient education (98%), adjusting medication dosages (97%), and conducting physical exams (96%). Over 90% felt very or somewhat comfortable diagnosing rheumatoid arthritis (RA) and a similar percentage prescribed DMARDs. Three-quarters reported using disease activity measures for RA and 56% reported that their practices used TTT strategies.
Conclusion
Most respondents reported they they had substantial patient care responsibilities, used disease activity measures for RA, and incorporated TTT in their practice. These data suggest mid-level providers may help to reduce shortages in the rheumatology workforce and conform with recommendations to employ TTT strategies in RA treatment.
Background
The Affordable Care Act proposes wider use of nurse practitioners (NPs) and physician assistants (PAs), but little is known about outcomes of care provided by them in medical specialties. We compared the outcomes of care for patients with rheumatoid arthritis (RA) seen in practices with NPs or PAs and rheumatologists versus practices with rheumatologists only.
Methods
We enrolled seven rheumatology practices in the US – four with NPs or PAs and three without. Disease activity of RA, categorized as remission, low, moderate, or high, using standardized measures were abstracted from medical records from the most recent two years. We performed a repeated measures analysis using generalized linear regression to compare disease activity for visits to practices with NPs or PAs versus rheumatologist only, adjusting for disease duration, serologic status, RA treatments and disease activity measures.
Results
Records from 301 patients, including 1982 visits were reviewed. Patients had a mean age of 61 years and 77% were female. In the primary adjusted analysis, patients seen in practices with NPs or PAs were less likely to have higher disease activity (OR 0.32, 95% CI 0.17–0.60, p = 0.004) than those seen in practices with rheumatologists only. However, there were no differences in the change in disease activity.
Conclusions
Patients seen in practices with NPs or PAs had lower RA disease activity over 2-years compared with those seen in rheumatologist only practices; no differences were observed in the change in disease activity between visits either within or between type of provider practice.
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