Study: Nonphysicians deliver same care as docs in community health centers

Team of doctors talking
A new study found care was comparable between doctors and nonphysician clinicians in community health centers.

Patients who see a nurse practitioner (NP) or physician assistant (PA) in community health centers receive comparable care to that of a physician, a new study has found.

The first-of-its-kind study, published in the journal Medical Care, looked at the quality of care provided by physicians and nonphysician clinicians in community health centers and found patients receive equivalent care based on health outcomes.

The study was conducted by researchers from George Washington University. "Findings from our study should be reassuring to patients who rely on community health centers for their care," lead author Ellen Kurtzman, an associate professor in the university’s School of Nursing, said in a study announcement. "We found that care is likely to be comparable regardless of whether patients are seen by a nurse practitioner, physician assistant or physician."

The study is the first to compare care in community health centers, which particularly serve patients in medically underserved areas who tend to be low-income, uninsured, immigrant and minority populations. Those centers often rely on nonphysicians to provide primary care.

The researchers reviewed five years of data on community health centers from the National Ambulatory Medical Care Survey and compared nine patient outcomes, including whether practitioners provided smoking cessation counseling, depression treatment and prescribed statins for high cholesterol levels. They also looked at physical exams, education services, imaging services, total medications and referral patterns. The study found similar quality, services and referrals by nonphysicians and physicians.

The researchers said the study is important for policymakers who are increasingly loosening restrictions on the autonomy of NPs and PAs. States across the country have eased scope of practice laws that allow NPs and PAs to care for patients independently, a trend expected to continue as one means to help relieve the shortage of physicians that has occurred in various parts of the country and is expected to get worse. These nonphysicians are also providing care at both workside clinics and retail clinics. Primary care practices are also using these clinicians in different ways, such as reaching out to patients with virtual visits.

In what was seen as a major victory for NPs, the Department of Veterans Affairs published a final rule in December that will expand the scope of practice of most advanced practice registered nurses who work for the agency.