Rising Numbers of Patients Seeing Non-Physician Clinicians, Study
Finds
ATLANTA -- In the decade between 1987 and 1997, the proportion of patients
in the United States who visited non-physician clinicians rose from
30 percent to 36 percent, says a new study by an Emory University health
policy professor and colleagues. This increase in treatment by health
care providers such as nurses, chiropractors, podiatrists and optometrists
reflected a growing number of patients receiving care from both physicians
and non-physicians, rather than an increase in independent treatment
by non-physicians, which declined during the study period.
Dr. Benjamin Druss, who holds
the Rosalynn Carter Chair of Mental Health in Emory's Rollins School
of Public Health, says these findings "show how the health workforce
has evolved during a time of great change in the US health system. Patients
are increasingly treated by multiple providers, who have a range of
training and philosophical approaches to treatment." Dr. Druss and co-authors
from Columbia University, the University of Pennsylvania, the University
of Pittsburgh, and RAND are publishing their findings in the January
9, 2003 issue of the New England Journal of Medicine.
They cite data showing that
in the 10-year study period, non-physicians were more likely to provide
preventive services, less likely to provide acute care (diagnosis and
treatment for specific illnesses), and more likely to work in the same
location as a physician, suggesting that they may be working conjointly
with physicians to care for patients.
The study draws on more than
40,000 individuals interviewed in national medical surveys conducted
in 1987 and 1997. The decade under review was one in which there was
an increase in the number of non-physician clinicians graduating from
training programs, in state laws allowing non-physicians a greater scope
of clinical practice, and in managed care plans that used these providers
to control costs.
"For patients, the implications
of these findings hinge on the degree to which physicians and non-physicians
are working together effectively," says Dr. Druss. "Multidisciplinary
teams can improve care, particularly for chronic conditions, but only
if that care is carefully coordinated. Without effective communication,
provision of care by multiple providers can reduce continuity and quality
of care. Given that patients are increasingly being treated by multiple
providers, it is essential to better understand and improve the degree
of integration between physician and non-physician clinicians in day-to-day
practice."
The study was sponsored by
the Robert Wood Johnson Foundation and the National Institute of Mental
Health. |