Study Supports Team Role for Physician Assistants and Nurse Practitioners
Madison, Wisconsin - In what’s believed to be the first study that compares the effectiveness of doctor-only care with team care that includes doctors and nurse practitioners (NPs) or physician assistants (PAs), researchers say that teams can produce equivalent or better outcomes for patients with chronic illness, particularly for patients with lower complexity.
Amid changes in health care and a continuing shortage of primary-care physicians, many health systems are moving to “team-based care,” in which NPs and PAs work with physicians to manage patient care. Since patients with chronic illnesses are far more likely to incur high costs, patient-centered medical homes — a team-based model meant to provide continuous and comprehensive care to patients — may be an answer.
“Team-based care is often considered a solution to some of the challenges of health system redesign,” said Dr. Maureen A. Smith, a study author and professor of population health sciences, family medicine and surgery at the University of Wisconsin School of Medicine and Public Health (SMPH).
The study in the November issue of Health Affairs examines the use of physician teams that include PAs and NPs compared to physicians only when caring for Medicare patients with diabetes.
“Our study suggests that nurse practitioners and physician assistants can play effective roles on primary care teams, particularly with patients who do not have high clinical complexity,” said Smith. “In situations where patients were not highly complex, including a nurse practitioner or physician assistant on the team with a physician led to equivalent or better outcomes as compared to physician alone.”
Although the results offer evidence that PAs and NPs can be effective in a range of roles on primary care teams, the findings also indicate that there may be notable exceptions and should be implemented after carefully considering patient needs, local populations, workforce constraints and organizational goals, like achieving accountable care organization quality metrics.
The study was authored by a group of investigators affiliated with the UW-Madison Health Innovation Program including Christine Everett, assistant professor in the Physician Assistant Program at the Duke University School of Medicine; Smith; Mari Palta, professor of population health sciences at the UW SMPH; Christie Bartels, assistant professor in the department of medicine at the UW SMPH; Pascale Carayon, professor of industrial and systems engineering at UW-Madison; and Carolyn Thorpe, a core investigator at the Center for Health Equity Research and Promotion – Veterans Affairs, and assistant professor of pharmacy and therapeutics at the School of Pharmacy, University of Pittsburgh.
Date Published: 11/04/2013