Academic journal article Journal of Allied Health

The Variation in Patient Care Rendered by Physicians and Nonphysician Clinicians in an Ambulatory Care Setting

Academic journal article Journal of Allied Health

The Variation in Patient Care Rendered by Physicians and Nonphysician Clinicians in an Ambulatory Care Setting

Article excerpt

This study compared three medical care services provided by a physician, a nonphysician clinician (NPC), and an NPC with a physician in ambulatory settings while measuring the trend in patients with essential hypertension and allergic rhinitis seen by these clinicians for the years 1999 through 2006. Multivariate analysis of variance and Z-test were used to analyze the data, while post hoc comparisons were performed using Scheffé test. There was a significant increase in the proportion of patients seen by an NPC with a physician for both diagnoses compared with the other two types of clinicians. The combination type prescribed significantly more medications than the other types, while there was moderate to substantial agreement in the choice of medications. Clinician type emerged as a prominent variable to explain the differences in how counseling services are provided, medications are prescribed, and diagnostic and screening services are ordered for patients with essential hypertension or allergic rhinitis in ambulatory settings. J Allied Health 2009; 38:227-235.

THE 1990s SAW AN EMPHASIS on the use of nonphysician clinicians (NPCs) as a strategy for containing health care costs. Most prominent among this group are nurse practitioners and physicians assistants. NPCs have experienced a growth of training and numbers similar to the growth of physicians in the 1970s1,2 that has continued to expand as predicted.3 In recent years, the supply of NPCs increased faster than that of physicians. Per capita supply of primary care physicians increased an average of about 1% per year, while the per capita supply of nonphysician primary care professionals increased an average of about 6% per year.4 Over the same period, the number of primary care ttaining programs for physicians declined while training programs for NPCs increased.

NPCs and physicians tend to follow similar patterns of disttibution, with most found in the Northeast and the fewest in the South. The proportion of patients who saw an NPC increased from 30.6% to 36.1% between 1987 and 1997.5

Coincident with the growth in numbers, the breadth of clinical responsibility available to NPCs has expanded. Physicians are no longer the sole providers of primary patient care. NPCs have significant latitude to diagnose and care for patients, including ordering and interpreting diagnostic tests, performing minor procedures, and prescribing medications. A growing body of research and extensive clinical experience show that NPCs are accepted by both patients and physicians; physicians are increasingly enlisting NPCs to extend their patient coverage capabilities,6 and NPC performance in terms of care provided, access, and cost-effectiveness is satisfactory.7

Reviews of comparison studies and individual studies comparing NPCs and physicians show that the care provided by NPCs functioning within their areas of training and expertise tends to be as good as or better than care provided by physicians.8,9

Prescribing practices of physicians and NPCs did not change significantly between 1996 and 2001. 10 Some found no differences between NPCs and physicians in the adequacy of theit prescribing practices.11-13 Others found that NPCs prescribe and use medications less frequently14 and tend to prescribe only well-known and relatively simple drugs.15

Studies that examined the diagnostic testing, screening, and counseling provided by clinicians suggest that NPCs have equal and perhaps better communication, counseling, and interviewing skills than physicians.7,12,16 NPCs tend to provide care to younger clients, perform fewer surgical procedures, and provide more health teaching/counseling interventions.17 Some physicians, however, are skeptical about the ability of NPCs to adequately perform common screening procedures.18

There are sparse data available, however, on how NPC growth has affected the ptactices of NPCs and/or in combination with physicians in ambulatory settings after 1997. …

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