Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA.
Hum Resour Health. 2012 Nov 13;10:42. doi: 10.1186/1478-4491-10-42.
Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA) has been a frontrunner in the use of nurse practitioners (NPs) and physician assistants (PAs). Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians.
This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician).
NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits.
This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.
初级保健是医疗体系公平性、效率和效果的重要决定因素，但初级保健提供者的供应和分布不足对其构成了威胁。退伍军人健康管理局（VHA）一直是在医疗体系中使用执业护士（NPs）和医师助理（PAs）的先驱。评估 VHA 中 NPs 和 PAs 的角色和影响对于确保退伍军人获得最佳护理至关重要，并且可能为全球其他环境中使用 PAs 和 NPs 的最佳实践提供信息。本研究的目的是描述 VHA 初级保健中 NPs 和 PAs 的使用情况，并检验他们的患者及其护理活动是否平均比医生的患者及其护理活动简单。
这是一项对 2005 年至 2010 年 VHA 初级保健就诊的行政数据进行的回顾性横断面分析。比较了不同提供者类型（PA、NP 和医生）的患者和患者就诊特征。
NPs 和 PAs 占所有 VHA 初级保健就诊的约 30%。NPs、PAs 和医生在 VHA 初级保健中扮演着相似的角色，但 PAs 和 NPs 的患者略低于医生的患者复杂，而且 PAs 参加更多的就诊是为了确定受益资格。
本研究表明，一个非常成功的全国性初级保健系统依赖 NPs 和 PAs 提供超过四分之一的初级保健就诊，并且这些就诊在患者和就诊特征方面与医生的就诊相似。这些发现可以为美国乃至全球的医生短缺问题提供卫生人力解决方案。未来的研究应该比较各种提供者组合和患者护理工作分配相关的质量和成本，并阐明最大化质量和效率的方法。
