February 2000 • Volume 6 • Number 2
Editorial, AAFP critique study of NPs, primary care physicians
Don't read too much into study findings that compare care by nurse practitioners and primary care physicians, warns an editorial accompanying the study report in the Jan. 5 Journal of the American Medical Association.
The study, "Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians -- A Randomized Trial," suggests that outcomes are similar for patients with asthma, diabetes or high blood pressure, whether they're seeing a primary care physician or a nurse practitioner. The editorial raises concerns about the study's external validity -- whether the findings are likely to apply to other study sites and other patient populations.
The study's lead author is Mary Mundinger, Dr.P.H., dean of the Columbia University School of Nursing in New York.
The population for the six-month study consisted of 1,316 younger, mostly female, Spanish-speaking immigrants who were on Medicaid.
"Although the study purports to show equal efficacy of doctors and nurses, we believe its substantial methodology weaknesses limit the applicability to that setting and population," said Academy EVP Robert Graham, M.D.
The Academy released a statement noting, "This study provides further evidence that primary care works. Patients were moved into clinical settings, away from ERs and urgent care centers, and their health improved.
"We caution that the conclusions of this study cannot be generalized. They are highly limited as to patient population, clinical structure, and the relatively short time period of this particular study. The authors also chose not to discuss the training and preparation of the nurses and physicians."
Medical students or residents with questions about the study's implications should speak with family practice faculty members or other family physicians, or call the AAFP at (800) 274-2237, Ext. 6710, says Deborah McPherson, M.D., assistant director of the AAFP Medical Education Division.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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