Impact of Physician Assistant Care on Office Visit Resource Use in the United States

Department of Community and Family Medicine, Duke University Medical Center, 3848 DUMC, Durham, NC 27710, USA.
Health Services Research (Impact Factor: 2.78). 08/2008; 43(5 Pt 2):1906-22. DOI: 10.1111/j.1475-6773.2008.00874.x
Source: PubMed


To investigate whether the use of physician assistants (PAs) as providers for a substantive portion of a patient's office-based visits affects office visit resource use.
Medical Expenditure Panel Survey (MEPS) Household Component data from 1996 to 2004.
This retrospective cohort study compares the number of office-based visits per year between adults for whom PAs provided >or=30 percent of visits and adults cared for by physicians only.
The Agency for Healthcare Research and Quality collects MEPS data using methods designed to produce data representative of the U.S. noninstitutionalized civilian population. Negative binomial regression was used to compare the number of visits per year between persons with and without PA care, adjusted for demographic, geographic, and socioeconomic factors; insurance status; health status; and medical conditions.
After case-mix adjustment, patients for whom PAs provided a substantive portion of care used about 16 percent fewer office-based visits per year than patients cared for by physicians only. This difference in the use of office-based visits was not offset by increased office visit resource use in other settings.
Results indicate that the inclusion of PAs in the U.S. provider mix does not affect overall office visit resource use.

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Available from: Perri A Morgan, Aug 25, 2014
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    • "The study by Morgan and colleagues (Morgan, et al., 2008) analyzed data from surveys conducted between 1996 and 2004 that asked respondents questions about their age, sex, race, rural/urban residence, health insurance, socioeconomic status, health status, medical conditions and the number of office visits they received from a PA or from a physician. The authors looked at outcomes in terms of number of office visits per patient and adjusted these results based on each patient's health status using a measure based on the constellation of diagnoses assigned to them. "
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    ABSTRACT: We conducted a literature review of studies on Physician Assistants working in a variety of settings and found few evaluation studies on the costs and/or effectiveness of Physician Assistants in primary care practices, Emergency Departments and in hospital settings other than Emergency Departments. The existing literature is limited because of the non-Canadian settings in which most studies have been performed and because of the non-experimental study designs, which are subject to potential bias. In addition, the research questions that have been addressed have tended to ignore what would appear to be the most important comparison: that between Physician Assistants and other non-physician providers such as Nurse Practitioners. The evidence we found on the cost-effectiveness of PAs is anecdotal and difficult to translate in the Ontario context. We conclude that it is difficult to make use of the existing literature. We recommend that MOHLTC consider options for funding a randomized control trial that might involve several trial arms in the particular sectors of relevance to the PA program, for example: physician only; physician and PA; physician and NP; and physician, NP and PA. The purpose of this would be to explore the difference in costs and effects on the different service modalities. This would also provide sufficient information to support modelling the short-run effects that could be expected from allocating the same amount of resources to the different service modalities as well as the implications for physician resources planning.
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    • "The question then becomes how tasks are allocated and shared, rather than a simplistic focus on a defender profession's exclusion and resistance to encroachment by claimants of turf. By the 1990s, health services researchers began to address these issues of task allocation, skill mix, and role substitution, and found that there was substantial overlap in the patient care activities of PAs, NPs, and physicians (Hooker, 1993; Kernick & Scott, 2002; Morgan et al., 2008; Richardson et al., 1998). Currently, NPs and PAs have legally established practice in every state of the US, and their numbers have increased so that there is about one PA or NP for every six to eight practicing physicians (AAPA, 2008; National Center for Health Statistics [NCHS], 2007; Pearson, 2009). "
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    ABSTRACT: Due to current or predicted health workforce shortages, policy makers worldwide are addressing issues of task allocation, skill mix, and role substitution. This article presents an example of this process in the United States (US). Health workforce analysts recommend that US physician workforce planning account for the impact of physician assistants (PAs) and nurse practitioners (NPs). We examined 40 state workforce assessments in order to identify best practices for including PAs/NPs. Most assessments (about 60%) did not include PAs/NPs in provider counts, workforce projections or recommendations. Only 35% enumerated PAs/NPs. Best practices included use of an accurate data source, such as state licensing data, and combined workforce planning for PAs, NPs, and physicians. Our findings suggest that interprofessional medical workforce planning is not the norm among the states in the US. The best practices that we identify may be instructive to states as they develop methods for assessing workforce adequacy. Our discussion of potential barriers to interprofessional workforce planning may be useful to policy makers worldwide as they confront issues related to professional boundaries and interprofessional workforce planning.
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