Do APCs Provide “Low-Value” Care More Frequently than Physicians?
Many believe that advanced practice clinicians [APCs (nurse practitioners and physician assistants)] present a solution to mitigate the workforce shortage in healthcare. However, according to a recent national survey, most physicians believe that APCs provide lower-quality care than they do, and nearly one quarter think that expanding nurse practitioners’ roles in U.S. practice would decrease the efficiency and value of health care. This is contradicted by previous research and systematic reviews that suggest that APCs provide care of the same quality as that of physicians.
A recent study sought to compare APCs and physicians directly with regard to ordering potentially guideline-discordant and “low-value” health services. Low-value health services are defined as patient care that typically portends a greater probability of harm than benefit, which has important implications for the quality and efficiency of care delivery in the U.S. health care system. The study used national data on ambulatory visits to providers to examine the treatment of three common conditions, upper respiratory illnesses (URI), headaches and back pain, that are frequently associated with the use of low-value services. They specifically looked at 3 types of outcomes widely considered to be low-value services in most cases—use of antibiotics (for URIs); plain radiography (for URIs and back pain); and advanced imaging, including both magnetic resonance imaging (MRI) and computed tomography (CT) (for back pain and headache)—as well as referrals to other physicians (for all 3 conditions), which generally are not required for these illnesses.
The results showed that APCs and physicians in both office and hospital-based primary care settings provided equivalent amounts of guideline-discordant low-value care. The authors note some important limitations such as the setting used to gather the sample, lack of longitudinal data, and they acknowledge that attributes of specific clinicians or practice settings might lead to practice patterns that differ from those they observed overall. However, the authors state that this study can dispel physicians’ perceptions that APCs provide more lower-value care.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: July 11, 2016
Source: Annals of Internal Medicine
Adapted from the original study.
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