Patients with coronary artery disease, heart failure, and atrial fibrillation receive comparable outpatient care from doctors and nurse practitioners, according to a US study.
The authors of the study suggest their findings support the increasing use of integrated primary care models, with a mix of healthcare professionals, as a way of overcoming staff shortages.
“It should be reassuring that the quality of care for uncomplicated outpatient CVD is at least equivalent between advanced practice providers and physicians”
They set out to compare care provided by primary care doctors with that received from advanced nurse practitioners and physician assistants – a type of clinical support role well established in the US but new to the UK, where they are more commonly known as physician associates.
The researchers assessed records from 648,909 patients receiving care in 90 general practices during 2012.
They compared quality of care among patients being treated by physician assistants and nurse practitioners, with those being treated in physician-only practices.
They looked at use of beta-blockers in patients with a history of heart attack, antiplatelet use, smoking screening and interventions to encourage smokers to quit, effective cholesterol control, referral to cardiac rehabilitation, and use of anticoagulation in patients with atrial fibrillation.
After adjusting for a range of factors, the researchers found that compliance with performance measures for coronary artery disease, heart failure, and atrial fibrillation were comparable across all practice types and clinicians.
The study found a higher rate of screening for smoking and interventions to encourage smokers to quit as well as a higher rate of referral to cardiac rehabilitation among advanced practice providers than among doctors.
“A collaborative care delivery model which employs both physicians and advanced practice providers appears to provide a care quality that is comparable to a physician-only model,” said lead study author Dr Salim Virani, from the Michael E. DeBakey Veterans Affairs Medical Center in Houston.
“Our results also have healthcare policy implications,” he said. “It should be reassuring that the quality of care for uncomplicated outpatient cardiovascular disease is at least equivalent between advanced practice providers and physicians.”
The findings were published this month in the Journal of the American College of Cardiology.