Factors associated with seeking physician care by medicare beneficiaries who receive all their primary care from nurse practitioners

Michelle Y. Raji, Nai Wei Chen, Mukaila Raji, Yong Fang Kuo

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: A shortage of primary care physicians has led to the alternative strategy of nurse practitioners (NPs) as primary care providers for the growing elderly population. Many states have implemented policies that allow NPs to practice independently with no physician oversight. Little is known about the continuity of primary care provided by NPs. Objective: To examine rate and correlates of switching from exclusive NP primary care to receiving some or all primary care from physicians. Design: A retrospective cohort study. Participants: Medicare beneficiaries (n = 38 618) with diabetes, congestive heart failure, or chronic obstructive pulmonary disease who received all their primary care from NPs in 2007. Main Measures: Multivariable logistic regression model was used to assess patient and disease characteristics associated with switching from sole NP primary care in 2007 to receiving some or all primary care from physicians between 2008 and 2010. Results: Of elderly patients receiving all their primary care from NPs in 2007, 53.8% switched to receiving some or all primary care from physicians in 2008-2010. The switching patients had less comorbidity before the switch and were more likely to reside in metropolitan areas, ZIP code areas with high education or states with the most restriction on NP scope of practice. In multivariable analyses, significant predictors of switching included one of the following within 30 days before the switch: emergency room visits (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.44-1.68), hospitalization (OR = 1.13, 95% CI = 1.02-1.25), new diagnosis of heart attacks (OR = 5.52, 95% CI = 4.33- 7.02), pneumonia (OR = 4.84, 95% CI = 3.71-6.32), atrial fibrillation (OR = 3.99, 95% CI = 2.93-5.44), stroke (OR = 2.94, 95% CI = 2.31-3.74), or cancer (OR = 2.65, 95% CI = 1.94-3.63). Conclusions: About half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period. Future study is needed to understand the reasons for switching.

Original languageEnglish (US)
Pages (from-to)249-257
Number of pages9
JournalJournal of primary care & community health
Volume7
Issue number4
DOIs
StatePublished - 2016

Fingerprint

Nurse Practitioners
Medicare
Primary Health Care
Physicians
Odds Ratio
Confidence Intervals
Primary Care Physicians
Logistic Models
Continuity of Patient Care
Atrial Fibrillation
Chronic Obstructive Pulmonary Disease
Hospital Emergency Service
Comorbidity
Pneumonia
Hospitalization
Cohort Studies
Heart Failure
Retrospective Studies
Stroke
Myocardial Infarction

Keywords

  • Discontinuity of care
  • Medicare
  • Nurse practitioner
  • Primary care

ASJC Scopus subject areas

  • Medicine(all)
  • Community and Home Care
  • Public Health, Environmental and Occupational Health

Cite this

@article{57bdb18c8e9748b2bc758d5d3e7a2a93,
title = "Factors associated with seeking physician care by medicare beneficiaries who receive all their primary care from nurse practitioners",
abstract = "Background: A shortage of primary care physicians has led to the alternative strategy of nurse practitioners (NPs) as primary care providers for the growing elderly population. Many states have implemented policies that allow NPs to practice independently with no physician oversight. Little is known about the continuity of primary care provided by NPs. Objective: To examine rate and correlates of switching from exclusive NP primary care to receiving some or all primary care from physicians. Design: A retrospective cohort study. Participants: Medicare beneficiaries (n = 38 618) with diabetes, congestive heart failure, or chronic obstructive pulmonary disease who received all their primary care from NPs in 2007. Main Measures: Multivariable logistic regression model was used to assess patient and disease characteristics associated with switching from sole NP primary care in 2007 to receiving some or all primary care from physicians between 2008 and 2010. Results: Of elderly patients receiving all their primary care from NPs in 2007, 53.8{\%} switched to receiving some or all primary care from physicians in 2008-2010. The switching patients had less comorbidity before the switch and were more likely to reside in metropolitan areas, ZIP code areas with high education or states with the most restriction on NP scope of practice. In multivariable analyses, significant predictors of switching included one of the following within 30 days before the switch: emergency room visits (odds ratio [OR] = 1.55, 95{\%} confidence interval [CI] = 1.44-1.68), hospitalization (OR = 1.13, 95{\%} CI = 1.02-1.25), new diagnosis of heart attacks (OR = 5.52, 95{\%} CI = 4.33- 7.02), pneumonia (OR = 4.84, 95{\%} CI = 3.71-6.32), atrial fibrillation (OR = 3.99, 95{\%} CI = 2.93-5.44), stroke (OR = 2.94, 95{\%} CI = 2.31-3.74), or cancer (OR = 2.65, 95{\%} CI = 1.94-3.63). Conclusions: About half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period. Future study is needed to understand the reasons for switching.",
keywords = "Discontinuity of care, Medicare, Nurse practitioner, Primary care",
author = "Raji, {Michelle Y.} and Chen, {Nai Wei} and Mukaila Raji and Kuo, {Yong Fang}",
year = "2016",
doi = "10.1177/2150131916659674",
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T1 - Factors associated with seeking physician care by medicare beneficiaries who receive all their primary care from nurse practitioners

AU - Raji, Michelle Y.

AU - Chen, Nai Wei

AU - Raji, Mukaila

AU - Kuo, Yong Fang

PY - 2016

Y1 - 2016

N2 - Background: A shortage of primary care physicians has led to the alternative strategy of nurse practitioners (NPs) as primary care providers for the growing elderly population. Many states have implemented policies that allow NPs to practice independently with no physician oversight. Little is known about the continuity of primary care provided by NPs. Objective: To examine rate and correlates of switching from exclusive NP primary care to receiving some or all primary care from physicians. Design: A retrospective cohort study. Participants: Medicare beneficiaries (n = 38 618) with diabetes, congestive heart failure, or chronic obstructive pulmonary disease who received all their primary care from NPs in 2007. Main Measures: Multivariable logistic regression model was used to assess patient and disease characteristics associated with switching from sole NP primary care in 2007 to receiving some or all primary care from physicians between 2008 and 2010. Results: Of elderly patients receiving all their primary care from NPs in 2007, 53.8% switched to receiving some or all primary care from physicians in 2008-2010. The switching patients had less comorbidity before the switch and were more likely to reside in metropolitan areas, ZIP code areas with high education or states with the most restriction on NP scope of practice. In multivariable analyses, significant predictors of switching included one of the following within 30 days before the switch: emergency room visits (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.44-1.68), hospitalization (OR = 1.13, 95% CI = 1.02-1.25), new diagnosis of heart attacks (OR = 5.52, 95% CI = 4.33- 7.02), pneumonia (OR = 4.84, 95% CI = 3.71-6.32), atrial fibrillation (OR = 3.99, 95% CI = 2.93-5.44), stroke (OR = 2.94, 95% CI = 2.31-3.74), or cancer (OR = 2.65, 95% CI = 1.94-3.63). Conclusions: About half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period. Future study is needed to understand the reasons for switching.

AB - Background: A shortage of primary care physicians has led to the alternative strategy of nurse practitioners (NPs) as primary care providers for the growing elderly population. Many states have implemented policies that allow NPs to practice independently with no physician oversight. Little is known about the continuity of primary care provided by NPs. Objective: To examine rate and correlates of switching from exclusive NP primary care to receiving some or all primary care from physicians. Design: A retrospective cohort study. Participants: Medicare beneficiaries (n = 38 618) with diabetes, congestive heart failure, or chronic obstructive pulmonary disease who received all their primary care from NPs in 2007. Main Measures: Multivariable logistic regression model was used to assess patient and disease characteristics associated with switching from sole NP primary care in 2007 to receiving some or all primary care from physicians between 2008 and 2010. Results: Of elderly patients receiving all their primary care from NPs in 2007, 53.8% switched to receiving some or all primary care from physicians in 2008-2010. The switching patients had less comorbidity before the switch and were more likely to reside in metropolitan areas, ZIP code areas with high education or states with the most restriction on NP scope of practice. In multivariable analyses, significant predictors of switching included one of the following within 30 days before the switch: emergency room visits (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.44-1.68), hospitalization (OR = 1.13, 95% CI = 1.02-1.25), new diagnosis of heart attacks (OR = 5.52, 95% CI = 4.33- 7.02), pneumonia (OR = 4.84, 95% CI = 3.71-6.32), atrial fibrillation (OR = 3.99, 95% CI = 2.93-5.44), stroke (OR = 2.94, 95% CI = 2.31-3.74), or cancer (OR = 2.65, 95% CI = 1.94-3.63). Conclusions: About half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period. Future study is needed to understand the reasons for switching.

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