Primary care physician assistant and advance practice nurses roles: Patient healthcare utilization, unmet need, and satisfaction

• Published in: Healthcare : the journal of delivery science and innovation 2016-12, Vol.4 (4), p.327-333
• Main Authors: Everett, Christine M, Morgan, Perri, Jackson, George L
• Format: Article
• Language: English
• Subjects: Adult; Advanced practice nurse; Aged; Cross-Sectional Studies; Emergency Service, Hospital; Hospitalization; Humans; Internal Medicine; Middle Aged; Nurse Practitioners; Patient Acceptance of Health Care; Patient Satisfaction; Physician assistant; Physician Assistants; Practice Patterns, Nurses; Primary care; Primary Health Care - organization & administration; Professional Role; Role; Surveys and Questionnaires; Young Adult
• ISSN: 2213-0764; 2213-0772
• DOI: 10.1016/j.hjdsi.2016.03.005

Abstract Purpose Team-based care involving physician assistants (PAs) and advance practice nurses (APNs) is one strategy for improving access and quality of care. PA/APNs perform a variety of roles on primary care teams. However, limited research describes the relationship between PA/APN role and patient outcomes. We examined multiple outcomes associated with primary care PA/APN roles. Methods In this cross-sectional survey analysis, we studied adult respondents to the 2010 Health Tracking Household Survey. Outcomes included primary care and emergency department visits, hospitalizations, unmet need, and satisfaction. PA/APN role was categorized as physician only (no PA/APN visits; reference), usual provider (PA/APN provide majority of primary care visits) or supplemental provider (physician as usual provider, PA/APN provide a subset of visits). Multivariable logistic and multinomial logistic regressions were performed. Results Compared to people with physician only care, patients with PA/APNs as usual providers [5–9 visits RRR=2.4 (CI 1.8–3.4), 10+ visits RRR=3.0 (CI 2.0–4.5): reference 2–4 visits] and supplemental providers had increased risk of having 5 or more primary care visits [5–9 visits RRR=1.3 (CI 1.0–1.6)]. Patients reporting PA/APN as supplemental providers had increased risk of emergency department utilization [2+ visits: RRR 1.8 (CI 1.3, 2.5)], and lower satisfaction [very dissatisfied: RRR 1.8 (CI 1.03–3.0)]. No differences were seen for hospitalizations or unmet need. Conclusions Healthcare utilization patterns and satisfaction varied between adults with PA/APN in different roles, but reported unmet need did not. These findings suggest a wide range of outcomes should be considered when identifying the best PA/APN role on primary care teams.