Cardiac Patients Receive as Good Care from Physicians, Advanced Practice Providers

Patients with coronary artery disease, heart failure, and atrial fibrillation receive comparable outpatient care from physicians and advanced practice providers — physician assistants and nurse practitioners – according to a US study published this week in the Journal of the American College of Cardiology.

Authors of the study suggest their findings support the increasing use of integrated primary care models, with a mix of healthcare professionals, as a way of overcoming staff shortages. A way to help ease the influx of patients insured under the Affordable Care Act and projected shortage of primary care physicians and specialists, which is expected to reach 90,000 by 2020.

The researchers assessed records from 648,909 patients receiving care in 90 general practices during 2012.

They compared quality of care among patients being treated by physician assistants and nurse practitioners, with those being treated in physician-only practices.

They looked at use of beta-blockers in patients with a history of heart attack, antiplatelet use, smoking screening and interventions to encourage smokers to quit, effective cholesterol control, referral to cardiac rehabilitation, and use of anticoagulation in patients with atrial fibrillation.

After adjusting for a range of factors, including provider gender, number of patients, and duration of time in the registry, as well as patients’ age, gender, insurance status and number of outpatient visits, researchers found that compliance with performance measures for coronary artery disease, heart failure, and atrial fibrillation were comparable across all practice types and clinicians.

The study found a higher rate of screening for smoking and interventions to encourage smokers to quit as well as a higher rate of referral to cardiac rehabilitation among advanced practice providers than among doctors.

“Our findings indicate that a collaborative care delivery model which employs both physicians and advanced practice providers appears to provide a care quality that is comparable to a physician-only model,” said Salim S. Virani, M.D., Ph.D., the study’s lead author and staff cardiologist at the Michael E. DeBakey Veterans Affairs Medical Center in Houston.

Salim believes the cardiovascular community can serve as a model for health policymakers, who “must be obliged to incorporate strong evidence into the deliberations and decisions that ultimately govern medical practice,” he said.

For more information visit the Journal of the American College of Cardiology.