PAs, NPs Make a Difference in Chronic Disease Care

I have recently been reviewing the case for acceptance of PAs by the public and the performance of PAs in a variety of clinical areas. The PA profession is still young in the scheme of medical professions, which means that there is not a lot a hard data to support what I intuitively know (after 34 years of practice) about the utility of PAs in all areas of medicine.

There have been a number of studies of performance of PAs and nurse practitioners (NPs) in recent years, however, and I will review the core ones supporting the case for the broad utilization of PAs (and NPs) in all aspects of the healthcare system.

Probably the most fundamental question regarding the acceptance of providers other than physicians in the healthcare system is how PAs and NPs are perceived by the health care consumer. A June 2013 article published in Health Affairs noted that more than 82 percent of patients surveyed were familiar with the concept of PAs and NPs prior to taking the survey. People are increasingly familiar with the concept of PAs and NPs as one of three providers who can provide primary patient care. The authors concluded that their findings show that healthcare consumers in the United States are open to the idea of seeing PAs and nurse practitioners-and in many cases prefer it. To be specific, patients seeking medical care were open to seeing a PA or NP earlier, as opposed to waiting to see a physician.

I have always preached that PAs and NPs are good at doing the things that made a difference in chronic disease. Patient education, access to care, and other critical components of a comprehensive approach to reducing patient morbidity and mortality are very important in the goal of keeping people happy. Diabetes is a critical chronic disease that causes substantial expenditures in the U.S. healthcare system and around the world. PAs and NPs can make a difference in this area of healthcare.

In an article published in MD Edge on July 11, 2014, the authors reported on a retrospective study of patients with diabetes seen by 19,238 physicians, PAs and NPs in the VA healthcare system from 2008 to 2012. They concluded that the characteristics, comorbidity levels, and HBA1c levels of patients with diabetes, after treatment, were similar among patients seen predominantly by physicians, NPs, or PAs.

Some have suggested that PAs and NPs may be seeing diabetic patients that are more stable, and fewer that are insulin dependent. However, this prospective study demonstrates that with an appropriate patient population, PAs and NPs are a vital component of the healthcare team in reducing the morbidity and mortality of chronic diseases like diabetes.

The next study, published by the American Heart Association in May 2015 had to do with cardiovascular disease (CVD) and was also performed in the VA healthcare system, the largest employer of PAs in the United States. Over one year for 2013 to 2014, more than one million patients were evaluated for three measures of CV care in a primary care setting: blood pressure of < 140/90, receiving a beta blocker, and receiving a statin. The results showed that blood pressure control was achieved more by PAs and NPs, and the criteria of beta blockers and statins were achieved more by physicians. Overall CV disease care quality between the providers did not differ, with 54.0 percent of those receiving care from physicians and 54.8 percent of those receiving care from PAs and NPs meeting all three eligible measures. What I found interesting about this is that while the care of physicians to PA/NPs was comparable, we could all do a better job in the outpatient treatment of CD disease in a primary care setting.

That sums up some of the data on the effectiveness of PAs and NPs in the delivery of chronic healthcare, and shows that they are an important adjunct to health care delivery teams in many settings. More data is needed, however, to better understand how PAs and NPs are accepted and perceived and how clinically effective they are.