Background: The current number of physicians will not be sufficient to accommodate 30 to 40 million Americans expected to secure health coverage with Affordable Care Act implementation. One proposed solution is to use advanced practice providers (APPs) (nurse practitioners and physician assistants).
Objectives: This study sought to determine whether there were clinically meaningful differences in the quality of care delivered by APPs versus physicians in a national sample of cardiology practices.
Methods: Within the American College of Cardiology's PINNACLE Registry, we compared quality of coronary artery disease (CAD), heart failure, and atrial fibrillation care delivered by physicians and APPs for outpatient visits between January 1, 2012, and December 31, 2012. We performed hierarchical regression adjusting for provider sex; panel size; duration of participation in registry; and patient's age, sex, insurance, number of outpatient visits, history of hypertension, diabetes, myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting in the preceding 12 months.
Results: We included 883 providers (716 physicians and 167 APPs) in 41 practices who cared for 459,669 patients. Mean number of patients seen by APPs (260.7) was lower compared with that seen by physicians (581.2). Compliance with most CAD, heart failure, and atrial fibrillation measures was comparable, except for a higher rate of smoking cessation screening and intervention (adjusted rate ratio: 1.14; 95% confidence interval: 1.03 to 1.26) and cardiac rehabilitation referral (rate ratio: 1.40; 95% confidence interval: 1.16 to 1.70) among CAD patients receiving care from APPs. Compliance with all eligible CAD measures was low for both (12.1% and 12.2% for APPs and physicians, respectively) with no significant difference. Results were consistent when comparing practices with both physicians and APPs (n = 41) and physician-only practices (n = 49).
Conclusions: Apart from minor differences, a collaborative care delivery model, using both physicians and APPs, may deliver an overall comparable quality of outpatient cardiovascular care compared with a physician-only model.
Download full-text PDF |
Source |
---|---|
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872507 | PMC |
http://dx.doi.org/10.1016/j.jacc.2015.08.017 | DOI Listing |
Indian J Med Ethics
January 2025
Senior Resident, Department of Forensic Medicine and Toxicology, AIIMS Bilaspur, Himachal Pradesh 174037, INDIA.
Telemedicine technology plays a crucial role in addressing healthcare challenges, particularly in countries like India, by mitigating physician shortages, reducing patient burden and costs, and aiding in disease prevention. The term telemedicine, meaning "healing at a distance," was coined in 1970 [1]. It encompasses the use of electronic, communication, and information technologies to deliver healthcare services remotely.
View Article and Find Full Text PDFAcad Emerg Med
January 2025
UnityPoint Health-Des Moines, Des Moines, Iowa, USA.
Introduction: The emergency physician (EP) workforce has been a recent focus after a workforce projection predicted a surplus of EPs by 2030. A previous study of Iowa emergency departments (EDs) demonstrated wide variability in ED staffing patterns and attributed it to the lack of EP job candidates. With the recent increase in emergency medicine (EM) residency positions, the objectives of this study were to understand how Iowa ED physician staffing has changed in regard to presence of board-certified EPs and what operational differences in Iowa EDs may be associated with staffing to provide insight into what may be occurring in other predominantly rural states.
View Article and Find Full Text PDFJ Med Syst
January 2025
Instituto Polibienestar, University of Valencia, Valencia, Spain.
The physician-patient relationship relies mostly on doctors' empathetic abilities to understand and manage patients' emotions, enhancing patient satisfaction and treatment adherence. With the advent of digital technologies in education, innovative empathy training methods such as virtual reality, simulation training systems, mobile apps, and wearable devices, have emerged for teaching empathy. However, there is a gap in the literature regarding the efficacy of these technologies in teaching empathy, the most effective types, and the primary beneficiaries -students or advanced healthcare professionals-.
View Article and Find Full Text PDFBackground: Neutropenia and febrile neutropenia (FN) are serious complications of myelosuppressive chemotherapy and present a considerable burden to patients with cancer. Febrile neutropenia is associated with increased risks of infection and hospitalization, a particular concern during the coronavirus disease 2019 (COVID-19) pandemic. Oncology nurses and advanced practice providers (APPs; including nurse practitioners, physician assistants, advanced practice nurses, and pharmacists) play a vital role in the management of patients with cancer and the prevention of infections.
View Article and Find Full Text PDFJ Adv Pract Oncol
November 2024
From Clemson University, Clemson, South Carolina.
Background: Patients with cancer routinely undergo genomic tumor sequencing, a component of molecular profiling (MP), to better characterize their cancer and identify potential targetable alterations. Targeted treatments potentially confer higher response rates and better efficacy. With increasing complexity, patients may require detailed explanations of MP results.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!