Ambulatory and Chronic Disease Care by Physician Assistants and Nurse Practitioners

Abstract

As the US population increases and ages, more patients require care. A reengineered health care system relies on physician assistants and nurse practitioners; however, the extent to which they care for medical conditions is marginally known. We analyzed ambulatory visits by provider type and diagnosis focusing on chronic diseases to identify differences in patients seen by each type of provider. Both physician assistants and nurse practitioners attended 14% of 777 million weighted visits. Overall, diabetes and hypertension accounted for 2% to 4% of visits. The distribution of visits for chronic disease diagnoses appears to be similar for all 3 providers (physicians, nurse practitioners, and physician assistants). These findings may improve organizational efficiency in ambulatory systems.

Nurse Practitioner Autonomy and Satisfaction in Rural Settings

“…It has been estimated that up to 75% of rural primary care services could be provided by NPs and PAs (Doescher, Andrilla, Skillman, Morgan, & Kaplan, 2014;Sullivan-Marx, 2008). NPs and PAs are proportionately more likely to work in rural communities than are physicians (Grumbach, Hart, Mertz, Coffman, & Palazzo, 2003;Hooker, Benitez, Coplan, & Dehn, 2013;Hooker & Berlin, 2002) and, in many rural communities, an NP or PA serves as the only primary care provider (National Advisory Committee on Rural Health & Human Services, 2010). In addition, prior research has found that NPs and PAs are more likely than physicians to serve as providers of care for patients enrolled in Medicaid or paying for care out-of-pocket, particularly in rural areas (Benitez, Coplan, Dehn, & Hooker, 2015;Skillman, Fordyce, Yen, & Mounts, 2012).…”

Ethics, equity, and economics

“…In collaboration with physician colleagues, PAs have expanded into nearly all areas of medicine; PAs increase access to primary care, are more likely than physicians to practice in rural, underserved areas, and are generally more satisfi ed with career choice than physicians. 22,25,26,28 The profession has made great strides in a short period of time due to the efforts of both men and women and, in general, women are as satisfi ed with the career choice of PA as men. 21,25 Unlike men, however, women cite issues related to respect as the most dissatisfying aspect of their careers.…”

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

“…This is half the percentage of ambulatory care visits for chronic diseases managed by PAs and NPs in similar studies. 23 This suggests that PAs and NPs may be underutilized in the care of individuals with depression. Increasing visits for adults with depression managed by PAs and NPs could increase access to care, which may help to increase healthcare system efficiency.…”

“…In the NHAMCS, the clinic is the destination of the patient and, thus, the visit is attributed to the clinician providing the service. 21,23 …”

“…Specifically, women and the uninsured are more likely to visit PAs and NPs, 19–21 while older patients 22,23 and those requiring more complex care 24 are more likely to visit physicians. However, mental health visits to PAs and NPs remains poorly understood.…”