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May 17, 2000

Health Outcomes Among Patients Treated by Nurse Practitioners or Physicians—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(19):2521-2524. doi:10.1001/jama.283.19.2521

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 examination.