Advanced Practice Clinicians and Physicians in Primary Care: Still More Questions than Answers
Authors: Eugene C. Rich
Journal: Annals of Internal Medicine (2016)

Editorials16 August 2016Advanced Practice Clinicians and Physicians in Primary Care: Still More Questions than AnswersEugene C. Rich, MDEugene C. Rich, MDFrom Center on Health Care Effectiveness, Mathematica Policy Research, Washington, DC.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1326 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The role of nurse practitioners (NPs) and physician assistants (PAs) in delivering high-quality, cost-effective primary care remains an important question for clinicians, practice leaders, and policymakers. Mafi and colleagues used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to seek insight into this issue, focusing on care of patients with 3 conditions commonly managed in primary care (upper respiratory infections [URIs], back pain, and headache) (1). They explore these rich sources of data to evaluate whether there are detectable differences between primary care physicians and advanced practice clinicians (APCs) in how often ...References1. Mafi JN, Wee CC, Davis RB, Landon BE. Comparing use of low-value health care services among U.S. advanced practice clinicians and physicians. Ann Intern Med. 2016;165:237-44. doi:10.7326/M16-2152 LinkGoogle Scholar2. Hughes DR, Jiang M, Duszak R. A comparison of diagnostic imaging ordering patterns between advanced practice clinicians and primary care physicians following office-based evaluation and management visits. JAMA Intern Med. 2015;175:101-7. [PMID: 25419763] doi:10.1001/jamainternmed.2014.6349 CrossrefMedlineGoogle Scholar3. Kuo YF, Goodwin JS, Chen NW, Lwin KK, Baillargeon J, Raji MA. Diabetes mellitus care provided by nurse practitioners vs primary care physicians. J Am Geriatr Soc. 2015;63:1980-8. [PMID: 26480967] doi:10.1111/jgs.13662 CrossrefMedlineGoogle Scholar4. Lin HC, Xirasagar S, Lin HC, Hwang YT. Does physicians' case volume impact inpatient care costs for pneumonia cases? J Gen Intern Med. 2008;23:304-9. [PMID: 18043982] CrossrefMedlineGoogle Scholar5. Balogh EP, Miller BT, Ball JR, eds. Committee on Diagnostic Error in Health Care; Board on Health Care Services; Institute of Medicine; The National Academies of Sciences, Engineering,and Medicine. Improving Diagnosis in Health Care. Washington, DC: National Academies Pr; 2015. Google Scholar6. Donelan K, DesRoches CM, Dittus RS, Buerhaus P. Perspectives of physicians and nurse practitioners on primary care practice. N Engl J Med. 2013;368:1898-906. [PMID: 23675658] doi:10.1056/NEJMsa1212938 CrossrefMedlineGoogle Scholar7. Reschovsky JD, Rich EC, Lake TK. Factors contributing to variations in physicians' use of evidence at the point of care: a conceptual model. J Gen Intern Med. 2015;30 Suppl 3:S555-61. [PMID: 26105673] doi:10.1007/s11606-015-3366-7 CrossrefMedlineGoogle Scholar8. O'Malley AS, Rich EC. Measuring comprehensiveness of primary care: challenges and opportunities. J Gen Intern Med. 2015;30 Suppl 3:S568-75. [PMID: 26105670] doi:10.1007/s11606-015-3300-z CrossrefMedlineGoogle Scholar9. Bazemore A, Petterson S, Peterson LE, Phillips RL. More comprehensive care among family physicians is associated with lower costs and fewer hospitalizations. Ann Fam Med. 2015;13:206-13. [PMID: 25964397] doi:10.1370/afm.1787 CrossrefMedlineGoogle Scholar10. O'Malley AS, Rich EC, Maccarone A, DesRoches CM, Reid RJ. Disentangling the linkage of primary care features to patient outcomes: a review of current literature, data sources, and measurement needs. J Gen Intern Med. 2015;30 Suppl 3:S576-85. [PMID: 26105671] doi:10.1007/s11606-015-3311-9 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Center on Health Care Effectiveness, Mathematica Policy Research, Washington, DC.Disclosures: Author has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1326.Corresponding Author: Eugene C. Rich, MD, Center on Health Care Effectiveness, Mathematica Policy Research, 1100 First Street Northeast, Washington, DC 20002; e-mail, [email protected]com.This article was published at www.annals.org on 21 June 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians John N. Mafi , Christina C. Wee , Roger B. Davis , and Bruce E. Landon Metrics Cited byPhysician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic reviewNational Nursing Association and Regulatory Authority Websites of Low-Income and Lower-Middle–Income CountriesOutcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of careLow‐ and lower middle‐income countries advanced practice nurses: an integrative reviewIntermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants A Cohort StudyGeorge L. Jackson, PhD, MHA, Valerie A. Smith, DrPH, David Edelman, MD, MHS, Sandra L. Woolson, MPH, Cristina C. Hendrix, DNS, GNP-BC, Christine M. Everett, PhD, MPH, PA-C, Theodore S. Berkowitz, MS, Brandolyn S. White, MPH, and Perri A. Morgan, PhD, PA-CComparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and PhysiciansPierre-Géraud Claret, MD, MSc, Xavier Bobbia, MD, and Jean Emmanuel de La Coussaye, MD, PhD 16 August 2016Volume 165, Issue 4Page: 290-291KeywordsAtrial premature contractionHeadachesHealth careInformation storage and retrievalLower back painMotivationNursesPatientsPrimary carePrimary care physicians ePublished: 21 June 2016 Issue Published: 16 August 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...