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that the mean age of patients seen by physicians was greater than that for
PAs or NPs. 253 The study also found that NPs provided counsel-ing/education during a higher proportion of visits than did PAs or physicians. 254 The authors suggest that PAs and NPs are providing primary care
in a way that is similar to physician care. 255 During the study period (1995-
1999), the proportion of patients who saw a PA or NP rose from 30.6% to
36.1%. 256 Other researchers compared the quality of clinical care performance of PAs to that provided by their employing or supervising physicians. 257 The study revealed that the patient care management decisions
made by PAs regarding certain morbidities were as good as, or better than,
those decisions made by physicians. 258
The effectiveness of health care delivery is contingent on the proper integration and mix of health care personnel. 259 In many settings, it is neither
necessary nor efficient for each patient to be seen by a physician. 260 PAs
are team-practice clinicians; the very nature of their clinical role is to work
with physicians in a collaborative process. 261 An effective PA provides care
comparable in quality to that of a physician. 262
Various studies have evaluated the relationship between the type of provider and the attainment of treatment goals for diabetes, dyslipidaemia, and
hypertension. 263 The VA Connecticut Health Care System conducted a
cross-sectional analysis of 19,660 patients with diabetes, coronary artery
disease, or hypertension. 264 While significant differences were noted in the
types of patients cared for by PA/NPs and resident physicians, attainment of
goals for each condition was similar, with one exception— PA/NP patients
were more likely than the patients of resident physicians to attain an
Practitioners in Primary Care 1995-1999, 20 HEALTH AFF. 231, 231 (2001).
255. Id. at 236.
256. Benjamin G. Druss et al., Trends in Care by Nonphysician Clinicians in the United
States, 348 NEW ENG. J. MED. 130, 130 (2003).
257. Robert L. Kane et al., Differences in the Outcomes of Acute Episodes of Care Provided by Various Types of Family Practitioners, 6 J. FAM. PRACTICE 133, 135 (1978).
259. Roderick S. Hooker & Christine M. Everett, The Contributions of Physician Assistants in Primary Care Systems, 20 HEALTH & SOC. CARE IN THE COMMUNITY. 20, 25 (2012).
263. George L. Jackson et al., Employment of Mid-level Providers in Primary Care and
Control of Diabetes, 5 PRIMARY CARE DIABETES, 25, 25 (2011); Pamela A. Ohman-Strickland et al., Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse
Practitioners and Physician’s Assistants, 6 ANNALS OF FAM. MED., 14, 14 (2008).
264. Daniel G. Federman et al., Relationship Between Provider Type and the Attainment of Treatment Goals in Primary Care, 11 AM. J. OF MANAGED CARE, 561, 561 (2005).