The variation in patient care rendered by physicians and nonphysician clinicians in an ambulatory care setting.

This study compared three medical care services provided by a physician, a nonphysician clinician (NPC), and an NPC with a physician in ambulatory settings while measuring the trend in patients with essential hypertension and allergic rhinitis seen by these clinicians for the years 1999 through 2006. Multivariate analysis of variance and Z-test were used to analyze the data, while post hoc comparisons were performed using Scheffe test. There was a significant increase in the proportion of patients seen by an NPC with a physician for both diagnoses compared with the other two types of clinicians. The combination type prescribed significantly more medications than the other types, while there was moderate to substantial agreement in the choice of medications. Clinician type emerged as a prominent variable to explain the differences in how counseling services are provided, medications are prescribed, and diagnostic and screening services are ordered for patients with essential hypertension or allergic rhinitis in ambulatory settings.