November 24, 2014
Most health policy experts agree that better leveraging advanced practice clinicians (APC) — specifically nurse practitioners and physician assistants — is the key to alleviating America’s growing shortage of primary care providers. While there are different proposals for how this should be done, the common theme is that APCs would ultimately service growing numbers of patients with a greater variety of maladies than currently seen by these professionals. Given the gap in training between APCs and physicians, this has the potential to greatly increase the use of tests as APCs work to find the appropriate diagnosis for their patients.
A Neiman Institute study published in JAMA Internal Medicine on November 24, 2014 examined this issue and found that across their study population patients were 34% more likely to receive an image if they were seen by an APC rather than a primary care physician. While the overall differential in imaging between these two groups was a relatively modest 1%, APCs increasingly ordered more imaging as they saw a broader range of clinical conditions — which could have important implications on patient safety and health care costs at the population level.
One policy prescription could be expanding the use of clinical decision support systems which have been shown to reduce inappropriate imaging and it’s associated costs. Regardless of the remedy, as increasing the use of APCs is clearly an important part of meeting America’s growing health care needs, careful attention must be made to ensure this doesn’t inappropriately increase the use of diagnostic services.