Factors Associated With Having a Physician, Nurse Practitioner, or Physician Assistant as Primary Care Provider for Veterans With Diabetes Mellitus

Expanded use of nurse practitioners (NPs) and physician assistants (PAs) is a potential solution to workforce issues, but little is known about how NPs and PAs can best be used. Our study examines whether medical and social complexity of patients is associated with whether their primary care provider (PCP) type is a physician, NP, or PA. In this national retrospective cohort study, we use 2012-2013 national Veterans Administration (VA) electronic health record data from 374 223 veterans to examine whether PCP type is associated with patient, clinic, and state-level factors representing medical and social complexity, adjusting for all variables simultaneously using a generalized logit model. Results indicate that patients with physician PCPs are modestly more medically complex than those with NP or PA PCPs. For the group having a Diagnostic Cost Group (DCG) score >2.0 compared with the group having DCG <0.5, odds of having an NP or a PA were lower than for having a physician PCP (NP odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.79-0.88; PA OR = 0.85, CI: 0.80-0.89). Social complexity is not consistently associated with PCP type. Overall, we found minor differences in provider type assignment. This study improves on previous work by using a large national dataset that accurately ascribes the work of NPs and PAs, analyzing at the patient level, analyzing NPs and PAs separately, and addressing social as well as medical complexity. This is a requisite step toward studies that compare patient outcomes by provider type.

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Utilization and Costs by Primary Care Provider Type

Medical Care ◽

10.1097/mlr.0000000000001326 ◽

2020 ◽

Vol 58 (8) ◽

pp. 681-688

Author(s):

Valerie A. Smith ◽

Perri A. Morgan ◽

David Edelman ◽

Sandra L. Woolson ◽

Theodore S.Z. Berkowitz ◽

...

Keyword(s):

Primary Care ◽

Care Provider ◽

Primary Care Provider ◽

Provider Type

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Primary care provider type

Journal of the American Academy of Physician Assistants ◽

10.1097/01.jaa.0000558239.06875.0b ◽

2019 ◽

Vol 32 (6) ◽

pp. 36-42 ◽

Cited By ~ 3

Author(s):

Christine M. Everett ◽

Perri Morgan ◽

Valerie A. Smith ◽

Sandra Woolson ◽

David Edelman ◽

...

Keyword(s):

Primary Care ◽

Care Provider ◽

Primary Care Provider ◽

Provider Type

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Development of a Unique Student Pharmacist Internship in a Primary Care Provider System

Pharmacy ◽

10.3390/pharmacy7020036 ◽

2019 ◽

Vol 7 (2) ◽

pp. 36

Author(s):

Norman E. Fenn ◽

Natalie R. Gadbois ◽

Gwen J. Seamon ◽

Shannon L. Castek ◽

Kimberly S. Plake

Keyword(s):

Primary Care ◽

Inventory Management ◽

Nurse Practitioners ◽

Care Provider ◽

Primary Care Provider ◽

Assistance Program ◽

North Central ◽

The North ◽

Contraceptive Devices ◽

One Year

Purpose: To describe a unique pharmacy intern program in a group of federally qualified health center (FQHC) outpatient primary care provider clinics. Summary: A pharmacy intern program was created at the North Central Nursing Clinics in Indiana, a group of four FQHC outpatient primary care provider facilities. Intern-performed tasks included: Prior authorization (PA) requests, medication assistance program (MAP) applications, sample procurement and inventory, and contraceptive devices for implantation inventory management. Interns interacted with clinic administration, nurse practitioners, and medical staff to complete their assigned responsibilities. Over a one-year period, the interns completed documentation on more than 2000 charts during a combined 12 h a week. Interns identified the interprofessional interactions as the most beneficial experience, while providers acknowledged no difference in the processing of paperwork during the transition of duties from pharmacy fellow to intern. Conclusion: This unique pharmacy intern program was successfully created and implemented in a primary care provider office, resulting in learning opportunities for pharmacy interns, as well as operational efficiencies to fellows, providers, and the organization.

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Patient preference in primary care provider type

Healthcare ◽

10.1016/j.hjdsi.2017.01.001 ◽

2018 ◽

Vol 6 (1) ◽

pp. 13-16 ◽

Cited By ~ 9

Author(s):

Brandi Leach ◽

Margaret Gradison ◽

Perri Morgan ◽

Christine Everett ◽

Michael J. Dill ◽

...

Keyword(s):

Primary Care ◽

Patient Preference ◽

Care Provider ◽

Primary Care Provider ◽

Provider Type

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Real-world comparison of HbA 1c reduction at 6-, 12- and 24-months by primary care provider type

Primary Care Diabetes ◽

10.1016/j.pcd.2018.01.008 ◽

2018 ◽

Vol 12 (4) ◽

pp. 319-324

Author(s):

Patricia A. Marin ◽

James F. Bena ◽

Nancy M. Albert

Keyword(s):

Primary Care ◽

Real World ◽

Care Provider ◽

Primary Care Provider ◽

Provider Type

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Primary Care Provider Attitudes and Perceptions of Routine Cognitive Screening in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.3257 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 882-882

Author(s):

Giovanna Potenza ◽

Meghan Mattos

Keyword(s):

Older Adults ◽

Primary Care ◽

Nurse Practitioners ◽

Care Provider ◽

Primary Care Provider ◽

Professional Organizations ◽

Cognitive Screening ◽

Provider Attitudes ◽

Attitudes And Perceptions ◽

Medicare Benefit

Abstract The 2011 Annual Wellness Visit (AWV) Medicare benefit includes a cognitive screening component intended to improve screening of older adults. However, available literature only presents physician perspectives on cognitive screening prior to 2011. The purpose of this study was to explore primary care provider (PCP) attitudes and perceptions of cognitive screening in older adults. An Internet-based survey link was sent to Virginia professional organizations and clinics to distribute to PCPs serving older adults. Likert scale, multiple choice, and free response questions were used to understand current attitudes, perceptions, and practices. The sample (N=39) was comprised of 26 nurse practitioners (NPs), 9 physicians, and four who did not disclose role. Most participants were aware of the AWV (n=31, 88.6%) and agreed that early detection “promotes earlier diagnosis and access to resources” (mean ± standard deviation,1.58±0.69). However, less than half of NPs screened annually (n=10/26, 38.5%) and even less conducted screening during an AWV (n=7/26, 26.9%). About half of MDs conducted cognitive screening during an AWV (n=5/9, 55.6%). Although NPs screened less, they more strongly agreed that screening should occur annually (1.92±1.15 vs. 2.67±1.23) and “additional training would improve [screening] ability” (2.04±1.0 vs. 3.22±1.20). Also, few NPs independently managed impairment (n=5/26, 19.2%) compared to MDs (n=5/9, 55.6%). Our findings demonstrate that NPs screen less and feel less prepared to conduct cognitive screenings. It is important to provide additional resources and training for all PCPs, but especially NPs who are rapidly entering primary care to help improve identification and management of cognitive impairment.

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