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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1024 — Patient and Provider Perceptions of Primary Care Nurse Practitioners in the VA

Lead/Presenter: George Sayre, COIN - Seattle/Denver
All Authors: Liu CF (COIN - Seattle/Denver) Neely EL (COIN - Seattle/Denver) Sulc CA (COIN - Seattle/Denver) Sales AE (COIN - Ann Arbor) Sayre GG (COIN - Seattle/Denver)

Nurse practitioners (NPs) serve an important role as primary care providers (PCPs). VA is the largest employer of NPs in the US, and has recently proposed to grant them full practice authority. This study assessed patient and provider perceptions of NP PCPs in VA.

We conducted semi-structured telephone interviews with VA patients and PCPs. We sampled NPs and MDs from geographically diverse VA Medical Centers and Community-based Outpatient Clinics, based on the NP authority at state level (full versus restricted practice). We sampled patients who had recently ( < 3 months) changed PCPs from MD to NP and from MD to MD.

We interviewed 31 PCPs (17 MDs and 14 NPs) and 22 patients (11 MD to NP and 11 MD to MD) before reaching thematic saturation. Provider experience, not provider type, was identified as the critical factor for effective patient management. The majority of PCPs felt NPs and MDs provided comparable quality of care and were equally efficient, and that differences between individual providers outweighed the differences between types. However, a few NPs and MDs from restricted states described NPs as less efficient, citing use of tests and consultations, spending more time with patients, smaller panels, greater attention to detail and supervision burden. MDs in restricted states were much more likely to report that patients had been transferred from NPs to MDs due to patient complexity. While narcotic seeking patients were identified by NPs and MDs as particularly challenging, MDs at restricted states identified this as a challenge for NPs much more frequently than NPs or MDs from full states. Most patients cared for by NPs seemed unaware of their provider type and when they mentioned NPs all but one focused on positive characteristics of NPs.

Most providers and patients did not distinguish between MD and NP effectiveness and efficiency. Provider concern with NPs appears more in restricted NP practice states. The same characteristics that MDs cited as contributing to NP inefficiency were valued by patients.

Provider trepidations regarding NP PCPs may be related to practice restrictions, and moving toward full practice authority across the VA may address this.