Quality of Care by Physicians, Nurse Practitioners, Physician Assistants Equal in Health Centers

In community health centers, nurse practitioners (NPs) and physician assistants (PAs) deliver care equivalent to that delivered by primary care physicians (PCPs), according to a new-first-of-its-kind study.

Under the Affordable Care Act, there’s a growing dependence on community health centers in the United States—–particularly among medically underserved areas that typically serve low-income, uninsured, minority, and immigrant populations. As a result, the health care system is increasingly relying on non-physician clinicians to provide primary care.

In a study published inMedical Care, investigators sought to assess the quality of patient care delivered by NPs, PAs, and PCPs in community health centers.

The investigators used 5 years of data from the National Ambulatory Medical Care Survey’s Community Health Center subsample and multivariate regression analysis to estimate the impact of receiving NP-delivered or PA-delivered care versus PCP-delivered care.

Included in the primary analyses were 23,704 patient visits to 1130 practitioners. The sample represented approximately 30 million patient visits to community health centers in the United States.

The investigators also examined 9 patient-level outcomes by practitioner type: 3 quality indicators (smoking cessation counseling, depression treatment, and ordering/prescribing of statins for hyperlipidemia), 4 measures of service utilization (physical exams, total number of health education/counseling services, imaging services, and total number of medications), and 2 measures of referral pattern (return visits at a specified time and physician referrals).

For 7 of 9 outcomes examined, the analysis results showed no statistically significant differences in NP or PA care compared with PCP care. For the remaining outcomes, visits to NPs were more likely to receive recommended smoking cessation counseling and more health education/counseling services than visits to PCPs. Furthermore, findings showed that visits to PAs also received more health education and counseling services compared with visits to PCPs.

“Across the outcomes studied, results suggest that NP and PA care were largely comparable to PCMD care in HCs,” the authors wrote.