Quality of HIV Health Care Provided by Nurse Practitioners, Physician Assistants, and Doctors

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The summary below is from the full report titled "Quality of HIV Care Provided by Nurse Practitioners, Physician Assistants, and Physicians." It is in the 15 November 2005 issue of Annals of Internal Medicine (volume 143, pages 729-736). The authors are I.B. Wilson, B.E. Landon, L.R. Hirschhorn, K. McInnes, L. Ding, P.V. Marsden, and P.D. Cleary.

What is the problem and what is known about it so far?

Nurse practitioners (NPs) and physician assistants (PAs) are health care providers who are trained to care for patients in much the same way as doctors. They can perform physical examinations, order tests and interpret results, make treatment decisions, and prescribe many drugs. By law, PAs require a doctor's supervision, whereas NPs do not. Many clinics and hospitals hire NPs and PAs to see patients when there are not enough doctors. Nurse practitioners and PAs also see patients with basic needs so that doctors' more limited time can be spent on patients with more complicated illnesses. Research suggests that NPs and PAs in primary care settings provide the same quality of care as doctors. However, these findings may not apply to specialty settings where patients' needs may be more complicated. Some clinics that focus on the care of patients with HIV infection employ NPs and PAs to see some patients. Whether the quality of care provided by NPs and PAs in an HIV clinic setting is similar to that provided by doctors is not known.

Why did the researchers do this particular study?

To compare the quality of health care provided by NPs, PAs, and doctors in HIV clinics.

Who was studied?

177 doctors and 66 NPs and PAs who took care of 6651 patients in 68 HIV clinics.

How was the study done?

The researchers randomly picked 5 health care providers from each HIV clinic. They sent a survey to the health care providers, asking them for information about their training and experience. The researchers also randomly chose 75 patients from each clinic. The researchers studied patients from the group who were cared for by a health care provider who had returned a survey. Nurses in each clinic reviewed the charts of the patients for indications that they received high-quality care. Measures of quality included control of HIV infection, screening for secondary infections, and immunizations. The researchers then compared the quality of care provided by NPs and PAs with that given by doctors. For the comparison, the researchers classified doctors as HIV experts with special training, HIV experts without special training, and non–HIV experts without special training.

What did the researchers find?

The quality of care provided by NPs and PAs was similar to or better than that provided by doctors. Nurse practitioners and PAs were better than all doctors at screening for tuberculosis and cervical cancer. They were better than non–HIV expert doctors without special training at giving proper anti-HIV drugs, controlling HIV infection, and giving flu shots. They did not perform worse than any other doctor at screening for hepatitis C infection and giving drugs to prevent a common cause of pneumonia.

What were the limitations of the study?

The researchers could not prove that the quality measures that they studied actually made patients healthier. Also, they studied aspects of health care that are basic for all patients with HIV. Nurse practitioners and PAs might not be as good as doctors in caring for patients with more complicated needs.

What are the implications of the study?

The quality of care provided by NPs and PAs is similar to or better than that provided by doctors in HIV clinics.