Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial | Asthma | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.226.234.102. Please contact the publisher to request reinstatement.
1.
Spitzer WO, Sackett DL, Sibley JC.  et al.  The Burlington randomized trial of the nurse practitioner.  N Engl J Med.1974;290:251-256.Google Scholar
2.
Brown SA, Grimes DE. A meta-analysis of nurse practitioners and nurse midwives in primary care.  Nurs Res.1995;44:332-339.Google Scholar
3.
US Congress, Office of Technology Assessment.  Nurse Practitioners, Physician Assistants, and Certified Nurse-Midwives: A Policy AnalysisWashington, DC: US Government Printing Office; 1986. Health Technology Case Study 37.
4.
Safriet BJ. Health care dollars and regulatory sense.  Yale J Regul.1992;9:417-488.Google Scholar
5.
Pearson LJ. Annual update of how each state stands on legislative issues affecting advanced nursing practice.  Nurse Pract.1999;24:16-19, 23-24, 27-30.Google Scholar
6.
 The Balanced Budget Act of 1997. Pub L No. 105-33.
7.
Mundinger MO. Advanced-practice nursing—good medicine for physicians?  N Engl J Med.1994;330:211-214.Google Scholar
8.
Bindman AB, Grumbach K, Osmond D.  et al.  Preventable hospitalizations and access to health care.  JAMA.1995;274:305-311.Google Scholar
9.
Billings J, Anderson GM, Newman LS. Recent findings on preventable hospitalizations.  Health Aff (Millwood).1996;15:239-249.Google Scholar
10.
Garfield R, Broe D, Albano B. The role of academic medical centers in delivery of primary care 1995.  Acad Med.1995;70:405-409.Google Scholar
11.
Ware Jr JE, Snow K, Kosinski M, Gandek B. SF-36 Health Survey: Manual & Interpretation GuideBoston, Mass: New England Medical Center; 1993.
12.
Ware Jr JE, Snow K, Kosinski M, Gandek B. SF-36 Physical and Mental Health Summary Scales: A User's ManualBoston, Mass: The Health Institute, New England Medical Center; 1994.
13.
Ware Jr JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36), I: conceptual framework and item selection.  Med Care.1992;30:473-483.Google Scholar
14.
McHorney CA, Ware Jr JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36), II: psychometric and clinical tests of validity in measuring physical and mental health constructs.  Med Care.1993;31:247-263.Google Scholar
15.
Shiely JC, Bayliss M, Keller S, Tsai C, Ware Jr JE. SF-36 Health Survey Annotated Bibliography: First Edition (1988-1995)Boston, Mass: The Health Institute, New England Medical Center; 1996.
16.
Tsai C, Bayliss M, Ware Jr JE. SF-36 Survey Annotated Bibliography: 1996 SupplementBoston, Mass: New England Medical Center; 1997.
17.
Sherbourne CD, Wells KB, Meredith LS, Jackson CA, Camp P. Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers.  Arch Gen Psychiatry.1996;53:889-895.Google Scholar
18.
Garratt AM, Ruta DA, Abdalla MI, Russell IT. SF-36 health survey questionnaire, II: responsiveness to changes in health status in four common clinical conditions.  Qual Health Care.1994;3:186-192.Google Scholar
19.
Mangione CM, Goldman L, Orav EJ.  et al.  Health-related quality of life after elective surgery.  J Gen Intern Med.1997;12:686-697.Google Scholar
20.
Rubin HR, Gandek B, Rogers WH, Kosinski M, McHorney CA, Ware Jr JE. Patients' ratings of outpatient visits in different practice settings: results from the Medical Outcomes Study.  JAMA.1993;270:835-840.Google Scholar
21.
Ware Jr JE, Bayliss MS, Rogers WH, Kosinski M, Tarlov AR. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems.  JAMA.1996;276:1039-1047.Google Scholar
22.
Deyo RA, Inui TS. Dropouts and broken appointments: a literature review and agenda for future research.  Med Care.1980;18:1146-1157.Google Scholar
23.
Vikander T, Parnicky K, Demers R, Frisof K, Demers P, Chase N. New-patient no-shows in an urban family practice center.  J Fam Pract.1986;22:263-268.Google Scholar
24.
Dockerty JD. Outpatient clinic nonarrivals and cancellations.  N Z Med J.1992;105:147-149.Google Scholar
25.
Kusek JW, Lee JY, Smith DE.  et al.  Effect of blood pressure control and antihypertensive drug regimen on quality of life.  Control Clin Trials.1996;17(suppl 4):40S-46S.Google Scholar
26.
Temple PC, Travis B, Sachs L, Strasser S, Choban P, Flancbaum L. Functioning and well-being of patients before and after elective surgical procedures.  J Am Coll Surg.1995;181:17-25.Google Scholar
27.
Kopjar B. The SF-36 health survey: a valid measure of changes in health status after injury.  Inj Prev.1996;2:135-139.Google Scholar
28.
Bertakis KD, Callahan EJ, Helms LJ, Azari R, Robbins JA, Miller J. Physician practice styles and patient outcomes.  Med Care.1998;36:879-891.Google Scholar
Original Contribution
January 5, 2000

Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial

Author Affiliations

Author Affiliations: School of Nursing (Drs Mundinger and Lenz and Ms Totten), Joseph L. Mailman School of Public Health (Dr Tsai), and College of Physicians and Surgeons (Dr Shelanski), Columbia University, New York, NY; University of Minnesota School of Public Health, Minneapolis (Dr Kane); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Cleary); Metropolitan Life Insurance Company, New York, NY (Dr Friedewald); and The Mount Sinai Medical Center, New York, NY (Dr Siu).

JAMA. 2000;283(1):59-68. doi:10.1001/jama.283.1.59
Abstract

Context Studies have suggested that the quality of primary care delivered by nurse practitioners is equal to that of physicians. However, these studies did not measure nurse practitioner practices that had the same degree of independence as the comparison physician practices, nor did previous studies provide direct comparison of outcomes for patients with nurse practitioner or physician providers.

Objective To compare outcomes for patients randomly assigned to nurse practitioners or physicians for primary care follow-up and ongoing care after an emergency department or urgent care visit.

Design Randomized trial conducted between August 1995 and October 1997, with patient interviews at 6 months after initial appointment and health services utilization data recorded at 6 months and 1 year after initial appointment.

Setting Four community-based primary care clinics (17 physicians) and 1 primary care clinic (7 nurse practitioners) at an urban academic medical center.

Patients Of 3397 adults originally screened, 1316 patients (mean age, 45.9 years; 76.8% female; 90.3% Hispanic) who had no regular source of care and kept their initial primary care appointment were enrolled and randomized with either a nurse practitioner (n = 806) or physician (n = 510).

Main Outcome Measures Patient satisfaction after initial appointment (based on 15-item questionnaire); health status (Medical Outcomes Study Short-Form 36), satisfaction, and physiologic test results 6 months later; and service utilization (obtained from computer records) for 1 year after initial appointment, compared by type of provider.

Results No significant differences were found in patients' health status (nurse practitioners vs physicians) at 6 months (P = .92). Physiologic test results for patients with diabetes (P = .82) or asthma (P = .77) were not different. For patients with hypertension, the diastolic value was statistically significantly lower for nurse practitioner patients (82 vs 85 mm Hg; P = .04). No significant differences were found in health services utilization after either 6 months or 1 year. There were no differences in satisfaction ratings following the initial appointment (P = .88 for overall satisfaction). Satisfaction ratings at 6 months differed for 1 of 4 dimensions measured (provider attributes), with physicians rated higher (4.2 vs 4.1 on a scale where 5 = excellent; P = .05).

Conclusions In an ambulatory care situation in which patients were randomly assigned to either nurse practitioners or physicians, and where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians, patients' outcomes were comparable.

×