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Letters
May 17, 2000

Health Outcomes Among Patients Treated by Nurse Practitioners or Physicians

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

To the Editor: The study by Dr Mundinger and colleagues1 compared the health outcomes of patients treated by nurse practitioners to those treated by physicians in primary care settings that were similar in terms of responsibilities and patient panels. There was no description of the training of either the physicians or the nurses in the study, other than that they were all faculty members. The authors state, "The combination of authority to prescribe drugs, direct reimbursement from most payers, and hospital admitting privileges creates a situation in which nurse practitioners and primary care physicians can have equivalent responsibilities." This combination does not include core elements of medical care such as evaluation, diagnosis, and treatment of undifferentiated patients. Patients with previously diagnosed and treated asthma, diabetes, and hypertension could be cared for successfully in a limited time frame by a person with less training than a physician. Each of these conditions has very clear treatment guidelines.

The most troublesome aspect of the study is the outcome measure. Although the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) is a well-established measure of health status, it assesses only self-reported perception of health. Furthermore, the sensitivity of the SF-36 for detecting longitudinal change within patients has been questioned.2 Patient satisfaction may be important but in itself is not a measure of the ability to provide many of the complicated aspects of patient diagnosis and care.

In the accompanying Editorial,3 Dr Sox states that the study has strong internal but weak external validity, and thus the conclusions of this study cannot be generalized. They are highly limited to this particular patient population and clinical structure and the relatively brief period of this study.

References
1.
Mundinger  MOKane  RLLenz  ER  et al.  Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial.  JAMA. 2000;283:59-68.Google Scholar
2.
Edelman  DWilliams  GRRothman  MSamsa  GP A comparison of three health status measures in primary care outpatients.  J Gen Intern Med. 1999;14:759-762.Google Scholar
3.
Sox  HC Independent primary care practice by nurse practitioners.  JAMA. 2000;283:106-107.Google Scholar
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