Role of Physician Assistants, Nurse Practitioners on Primary Care Teams Examined in AHRQ Study

Decisions about which health care services should be provided by physician assistants (PAs) and nurse practitioners (NPs) on the primary care team should be based on factors such as patient characteristics and identified goals, according to a new AHRQ study published online in the November issue of Health Affairs. The study, “Physician Assistants and Nurse Practitioners Perform Effective Roles on Teams Caring for Medicare Patients With Diabetes,” compared outcomes in diabetes care for more than 2,500 Medicare patients in a large multi-specialty physician practice. Patients were sorted into two groups: those whose primary care teams included PAs and NPs in various roles, and those who received care from physicians only. Outcomes were generally the same for both groups in 13 of 20 comparisons. For four comparisons the PA/NP outcomes were better, and for three comparisons the physician-only outcomes were better. Select to access the journal abstract on PubMed®.

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2013 Nov;32(11):1942-8. doi: 10.1377/hlthaff.2013.0506.

Physician assistants and nurse practitioners perform effective roles on teams caring for medicare patients with diabetes.

Everett C, Thorpe C, Palta M, Carayon P, Bartels C, Smith MA.

Abstract

One approach to the patient-centered medical home, particularly for patients with chronic illnesses, is to include physician assistants (PAs) and nurse practitioners (NPs) on primary care teams. Using Medicare claims and electronic health record data from a large physician group, we compared outcomes for two groups of adult Medicare patients with diabetes whose conditions were at various levels of complexity: those whose care teams included PAs or NPs in various roles, and those who received care from physicians only. Outcomes were generally equivalent in thirteen comparisons. In four comparisons, outcomes were superior for the patients receiving care from PAs or NPs, but in three other comparisons the outcomes were superior for patients receiving care from physicians only. Specific roles performed by PAs and NPs were associated with different patterns in the measure of the quality of diabetes care and use of health care services. No role was best for all outcomes. Our findings suggest that patient characteristics, as well as patients' and organizations' goals, should be considered when determining when and how to deploy PAs and NPs on primary care teams. Accordingly, training and policy should continue to support role flexibility for these health professionals.