For patients with chronic obstructive pulmonary disease (COPD) who have been previously hospitalized, the rates of rehospitalization or readmission for COPD do not differ between patients treated by physicians or those treated by nurse practitioners/physician assistants, according to a study published in PLoS ONE.
There were some differences both in how patients were treated and their outcomes depending on whether they were treated by a physician or NP/PA. NPs/PAs were more likely to prescribe patients short-acting bronchodilator (adjusted odds ratio [aOR] = 1.18) or oxygen therapy (aOR = 1.25), and they were more likely to refer patients to a pulmonologist (aOR = 1.39). However, NPs/PAs were less likely to administer influenza vaccines (aOR = 0.67) or pneumonia vaccines (aOR = 0.80) to patients.
Compared with patients treated by physicians, patients treated by NPs/PAs had lower rates of emergency room visits for COPD (aOR = 0.84), as well as a higher follow-up rate with a pulmonologist within 30 days of hospitalization (aOR = 1.25).
The study included 7,357 Medicare beneficiaries with COPD. For their primary care, 1,999 patients saw PAs/NPs, and 5,238 saw physicians. Patients who saw PAs or NPs were more likely to be white, younger, male, living in non-metropolitan areas, and have fewer comorbidities.
“It is estimated that [NPs and PAs] could provide care for 50% to 90% of patients presenting to primary care,” the researchers wrote. “With the increasing number of [NPs and PAs] as primary care providers, they will be more likely to be called upon to manage patients with such chronic conditions as COPD.”
- Agarwal A, Zhang W, Kuo Y, et al. Process and outcome measures among COPD patients with a hospitalization cared for by an advance practice provider or primary care physician. PLoS One. 2016;11(2):e10148522.