NPs, PAs Beat Physicians at Preventing ER Visits Among COPD Patients

Patients with chronic obstructive pulmonary disease (COPD) are less likely to visit the emergency room (ER) when they receive care from a nurse practitioner (NP) or physician assistant (PA) instead of a physician.

Amitesh Agarwal, MD, a fellow at the University of Texas Medical Branch, toldContemporary Clinicthat this fact was the most surprising finding from his research on care outcomes for COPD patients. He added that he sees NPs and PAs growing in importance as they continue to fill gaps in primary care needs.

Dr. Agarwal and his fellow researchers noted that NPs and PAs are increasingly being tapped to provide care as the primary care physician workforce sees demand exceeding supply. This perceived shortage may be due in part to an increase in older adults, a greater number of patients with chronic comorbidities, and the additional 13 million or sonewly insured patients needing services under the Affordable Care Act, the researchers stated.

As advanced practice clinicians take on more responsibility with chronic diseases such as COPD, diabetes, and hypertension, some physician organizations havequestioned the quality of their patient care services. However, Dr. Agarwal’s study provided evidence of the benefits of seeing an advanced practice provider, at least for COPD care.

The study involved more than 7200 Medicare beneficiaries with COPD. Nearly 2000 of these patients received care from an NP or PA, and the remaining 5200 or so received care from a primary care physician. The advanced practice clinician group had more patients who were white, younger, male, living in non-metropolitan areas, and had fewer comorbidities.

Around 77% of the advanced practice clinician group was cared for by NPs alone, 10% were cared for by PAs, and the rest saw both.

The outcome measures that most interested the researchers were ER visits, number of hospitalizations, and 30-day readmission rates in 2010. They found that NPs and PAs were more likely to prescribe short-acting bronchodilators, oxygen therapy, and a consultation with a pulmonary specialist.

“The more frequent specialist consults with NPs’ care may be due to the recognized need for expertise and skills outside of the NP’s scope of practice for complex patients,” the study authors stated.

The advanced practice clinicians were less likely to provide influenza and pneumococcal vaccinations, which is one area where NPs and PAs can improve. However, a contributing factor may have been the patients’ younger ages, the study authors noted.

Nonetheless, those who saw advanced practice clinicians had lower rates of ER visits for COPD and higher follow-up rates with a pulmonary specialist within 30 days of hospitalization for COPD than those who were cared for by a physician.

There were no differences in hospitalization or readmission for COPD between the 2 groups.