Study Finds Differences in COPD Care Between Doctors, Nurse Practioners, and Physician Assistants

A new study investigated the differences in the services provided to patients with chronic obstructive pulmonary disease (COPD) by doctors and by nurse practitioners and physician assistants. The study was conducted by researchers from The University of Texas Medical Branch (UTMB) at Galveston, and published in the scientific periodical PLOS ONE, titled “Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician.”

The United States is undergoing a shortage of primary care physicians while at the same time, due to an increasingly older population, chronic diseases are climbing. Also, 13 million newly insured patients need medical services under the Affordable Care Act.

Due to this rising need of primary care providers, several health organizations are looking into alternatives by hiring more advance practice providers (APPs), including physician assistants and nurse practitioners.

Inevitably, APPs are increasingly contributing to the care of patients with lifelong manageable chronic diseases, such as COPD. But some physician organizations claim APPs have less preparation and practical experience, and do not deliver the same high-quality services as physicians.

The research team looked into this question, and examined the quality of COPD primary care nationwide provided by physicians compared to APPs. The records of 7,257 COPD patients on Medicare who had visited the hospital at least once were included in the cross-sectional cohort study’s review.

The researchers searched for tests to verify breathing capacity, pneumonia and flu vaccines, COPD medications, and referrals to pulmonary specialists. The outcome measures used in the study included visits to the emergency room, number of hospitalizations, and re-admissions within the first month of release from the last hospital visit.

“We found that APPs were more likely to prescribe short-acting inhalers or oxygen therapy and to consult with a pulmonary specialist, but less likely to give flu and pneumonia vaccinations compared to physicians,” the study’s lead author and UTMB fellow, Amitesh Agarwal, M.D., said in a press release. “Patients receiving care from APPs had lower rates of [emergency room] visits for COPD and a higher follow-up rate with a pulmonologist within 30 days of hospitalization for COPD than those cared for by a physician.”

Agarwal and his team concluded that:

• Recurrent specialist consults with APP care might be attributed to the recognition of a need for proficiency and knowledge outside of the APPs’ scope of practice;
• Concerning the lower use of flu vaccination in the APP group, this is probably linked to the lower age group of COPD patients under their assistance.

The team concluded that the APPs group had fewer follow-up clinic visits post-hospitalization for sudden COPD flare-ups compared to the primary care physician group. Still, patients who were under APP care had more follow-up visits to the clinic with a pulmonary specialist than the patients of physicians, which might help explain the lower trends in emergency room visits and re-admissions.