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British Medical JournalProvision of Evaluation and Management Visits by Nurse Practitioners and Physician Assistants in the USA from 2013 to 2019: Cross-sectional Time Series study

A Quarter of All Healthcare Visits Now Conducted by Non-Physician Providers

A recent cross-sectional time series study looks into the evolving landscape of healthcare delivery in the United States, particularly focusing on the roles of nurse practitioners and physician assistants. Utilizing national Medicare data, the study reveals a significant uptick in the proportion of healthcare visits managed by these professionals.

HCN Medical Memo
For healthcare professionals, this study sheds light on the expanding role of nurse practitioners and physician assistants in the US healthcare system. As these providers now account for a quarter of all healthcare visits, understanding their growing contributions is essential for collaborative and effective patient care.

Study Design
  • Setting: National data from the traditional Medicare insurance program in the USA.
  • Participants: A 20% random sample of Medicare users, including those older than 65, permanently disabled, and people with end-stage renal disease.
  • Time Frame: Data collected from January 1, 2013, to December 31, 2019.
  • Main Outcome Measures: Proportion of visits in outpatient and skilled nursing facilities delivered by physicians, nurse practitioners, and physician assistants.

In 2019, 41.9% of all patients with at least one healthcare visit had one or more visits with a nurse practitioner or physician assistant.

Key Findings
  • The proportion of visits conducted by nurse practitioners and physician assistants increased from 14.0% in 2013 to 25.6% in 2019.
  • In 2019, the proportion of visits by these providers varied by condition: 13.2% for eye disorders, 20.4% for hypertension, 36.7% for anxiety disorders, and 41.5% for respiratory infections.
  • Among all patients with at least one visit in 2019, 41.9% had one or more visits with a nurse practitioner or physician assistant.
  • Patients more likely to receive care from these providers were lower-income (2.9% greater likelihood), rural residents (19.7%), and disabled (5.6%).

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