Study Shows Trends in Visits to NPs and PAs For Specialty Care Has Increased

The involvement of nurse practitioners (NPs) and physician assistants (PAs) in the care of patients of specialist physicians has increased over the past decade, but growth slowed in recent years, and visits involving NPs or PAs remain a small proportion of overall specialty visits, according to a research letter published June 5 in JAMA Internal Medicine.

Kristin Ray, MD, MS, et al., looked at the National Center for Health Statistics' National Ambulatory Medical Care Survey which includes 473,132 outpatient care visits from 2001 to 2013.

Results showed that among visits to surgical and medical specialist physicians, the proportion involving an NP or PA increased from 3.3 percent in 2001 to 2003 to 6.9 percent in 2010 to 2013 (P = .001) and 2.4 percent to 5.8 percent (P < .001), respectively. Similar growth in NP or PA visits was observed for new and return visits and for all visit reasons (i.e., acute problem, routine chronic, perioperative). Further, among visits with NPs or PAs, the proportion of visits where the patient did not also see a physician increased from 12.3 percent to 21.4 percent (P = .004).

However, the authors note that in adjusted analysis, NPs or PAs were "disproportionately involved in care of patients with greater medical complexity, requiring further work to understand if this reflects team-based care, coding artifact, or other explanations."

Moving forward, the authors conclude that their findings "have implications for the specialty workforce, and the impact on access to specialty care and its quality should be evaluated."

Keywords: Ambulatory Care, Artifacts, Health Care Surveys, Internal Medicine, National Center for Health Statistics (U.S.), Nurse Practitioners, Physician Assistants

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