|
|
Quality of HIV care provided by nurse practitioners, physician assistants, and physicians.
Wilson IB, Landon BE, Hirschhorn LR, McInnes K, Ding L, Marsden PV, Cleary PD.
Ann Intern Med
2005 Nov 15;143(10):729-36.
Abstract
BACKGROUND: Nurse practitioners (NPs) and physician assistants (PAs) are primary care providers for patients with HIV in some clinics, but little is known about the quality of care that they provide. OBJECTIVE: To compare the quality of care provided by NPs and PAs with that provided by physicians. DESIGN: Cross-sectional analysis. SETTING: 68 HIV care sites, funded by Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Title III, in 30 different states. PARTICIPANTS: The authors surveyed 243 clinicians (177 physicians and 66 NPs and PAs) and reviewed medical records of 6651 persons with HIV or AIDS. MEASUREMENTS: 8 quality-of-care measures assessed by medical record review. RESULTS: After adjustments for patient characteristics, 6 of the 8 quality measures did not statistically significantly differ between NPs and PAs and either infectious disease specialists or generalist HIV experts. Adjusted rates of purified protein derivative testing and Papanicolaou smears were statistically significantly higher for NPs and PAs (0.63 and 0.71, respectively) than for infectious disease specialists (0.53 [P = 0.007] and 0.56 [P = 0.001], respectively) or generalist HIV experts (0.47 [P < 0.001] and 0.62 [P = 0.025], respectively). Nurse practitioners and PAs had statistically significantly higher performance scores than generalist non-HIV experts on 6 of the 8 quality measures. LIMITATIONS: These results may not be generalizable to care settings where on-site physician HIV experts are not accessible or to measures of more complex clinical processes. CONCLUSIONS: For the measures examined, the quality of HIV care provided by NPs and PAs was similar to that of physician HIV experts and generally better than physician non-HIV experts. Nurse practitioners and PAs can provide high-quality care for persons with HIV. Preconditions for this level of performance include high levels of experience, focus on a single condition, and either participation in teams or other easy access to physicians and other clinicians with HIV expertise.
Go to
PubMed entry
|
Reviewed by
Susa Coffey, MD
Comment
The HIV expertise of physicians and of clinic settings has been shown to be associated with better care of HIV-infected patients. The present study evaluates the quality of HIV care provided by nurse practitioners (NPs) and physician assistants (PAs) compared with that provided by physicians.
Researchers reviewed the records of more than 6,000 patients at 68 clinics funded by the Ryan White Care Act for the years 1999-2001 and evaluated 8 quality-of-care measures, such as rates of antiretroviral therapy (ART) use, HIV viral load,
Pneumocystis jiroveci
pneumonia prophylaxis, and tuberculosis screening. They found that patients primarily cared for by NPs and PAs were quite similar to those seen by physicians, though they had somewhat fewer non-HIV-related comorbidities and were more likely to have active substance abuse. Analysis of the selected quality-of-care measures showed that NPs and PAs had similar or better performance rates than physicians.
For 6 criteria, including HIV-specific measures such as ART use and HIV viral load, performance rates were significantly higher for NPs and PAs than for non-HIV-expert physicians, and were similar to those of infectious disease or HIV-expert physicians. For 2 measures, tuberculosis skin testing and pap smears, NPs and PAs had higher performance rates than any physician group.
This study, though based on somewhat outdated criteria, reaches a conclusion that will be no surprise to HIV providers who work in mixed MD/NP/PA practices: that NPs and PAs in the HIV treatment clinics studied here provided high-quality HIV care to their patients. The authors of this study suggest that
certain practice characteristics may enhance the performance of nonphysician primary care providers; these include a high level of HIV experience, specialization in a single condition, and ready access to consultation with HIV-expert physicians.
|
