Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial

Mary O. Mundinger, Robert L. Kane, Elizabeth R. Lenz, Annette Totten, Wei Yann Tsai, Paul D. Cleary, William T. Friedewald, Albert L. Siu, Michael L. Shelanski

Research output: Contribution to journalArticle

617 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)59-68
Number of pages10
JournalJournal of the American Medical Association
Volume283
Issue number1
StatePublished - Jan 5 2000
Externally publishedYes

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Nurse Practitioners
Primary Health Care
Physicians
Appointments and Schedules
Primary Care Physicians
Ambulatory Care
Health Status
Health Services
Outcome Assessment (Health Care)
Aftercare
Quality of Health Care
Emergency Medical Services
Patient Satisfaction
Hispanic Americans
Hospital Emergency Service
Asthma

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A., Tsai, W. Y., Cleary, P. D., ... Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 283(1), 59-68.

Primary care outcomes in patients treated by nurse practitioners or physicians : A randomized trial. / Mundinger, Mary O.; Kane, Robert L.; Lenz, Elizabeth R.; Totten, Annette; Tsai, Wei Yann; Cleary, Paul D.; Friedewald, William T.; Siu, Albert L.; Shelanski, Michael L.

In: Journal of the American Medical Association, Vol. 283, No. 1, 05.01.2000, p. 59-68.

Research output: Contribution to journalArticle

Mundinger, MO, Kane, RL, Lenz, ER, Totten, A, Tsai, WY, Cleary, PD, Friedewald, WT, Siu, AL & Shelanski, ML 2000, 'Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial', Journal of the American Medical Association, vol. 283, no. 1, pp. 59-68.
Mundinger, Mary O. ; Kane, Robert L. ; Lenz, Elizabeth R. ; Totten, Annette ; Tsai, Wei Yann ; Cleary, Paul D. ; Friedewald, William T. ; Siu, Albert L. ; Shelanski, Michael L. / Primary care outcomes in patients treated by nurse practitioners or physicians : A randomized trial. In: Journal of the American Medical Association. 2000 ; Vol. 283, No. 1. pp. 59-68.
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