Efficiency and cost of primary care by nurses and physician assistants.
We conducted a prospective study in a prepaid primary-care practice (health-maintenance organization) of a system in which nurses and physician assistants used protocols, and compared the efficiency and costs of this "new-health-practitioner" protocol system to a physician-only nonprotocol system. In five months, we studied 472 patients with any of four common acute complaints--respiratory infections, urinary and vaginal infections, headache, and abdominal pain; a subset of 203 patients was randomly allocated between the two systems. In the new-health-practitioner system physician time per patient was reduced by 92 per cent, from 11.8 to 0.9 minutes, and average visit costs--including practitioner time and charges for laboratory tests and medications--were 20 per cent less (P = 0.01). We conclude that this protocol system saves physician time and reduces costs.
D000005:Abdomen; D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D004526:Efficiency; D005260:Female; D006261:Headache / Q000628:therapy; D006279:Health Maintenance Organizations; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009722:Nurse Practitioners; D059408:Pain Management; D010823:Physician Assistants; D010821:Physicians, Family; D011320:Primary Health Care / Q000191:economics*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000628:therapy; D014481:United States; D014552:Urinary Tract Infections / Q000628:therapy; D000078329:Workforce