Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor
In Reply: Many of the above comments challenge
the generalizability of our findings. We appreciate this limitation but believe
that our results are suggestive enough to open more active discussion about
the appropriate role of various primary care practitioners.
Dr Bagley, Dr Chan-Tack, Dr Hicks, and Dr Rayburn all raise questions
about the supposed healthy nature of our population and the relative ease
of using practice guidelines to care for patients with chronic conditions.
The high burden of illness in the population is reflected in their SF-36 scores,
which were 35% lower on average than a national sample of similar age and
sex.1 Moreover, very few patients had only
a single previously diagnosed condition. Less than 5% (58 of 1316) of the
study patients were treated in the first 6 months of the study for only 1
of the chronic conditions (or for a related diagnosis) or had a general medical
Mundinger MO, Kane RL. Health Outcomes Among Patients Treated by Nurse Practitioners or Physicians—Reply. JAMA. 2000;283(19):2521-2524. doi:10.1001/jama.283.19.2521