Case management by physician assistants and primary care physicians vs emergency physicians.
OBJECTIVE
To determine whether physician assistants' (PAs') and primary care physicians' (PCPs') case management for 5 common primary care medical problems is similar to that of emergency physicians (EPs).


METHODS
An anonymous survey was used to compare PAs, PCPs, and EPs regarding intended diagnostic and treatment options for hypothetical cases of asthma, pharyngitis, cystitis, back strain, and febrile child. Published national practice guidelines were used as a comparison criterion standard where available. The participants stated that they treated all of the patients and responded to all of the cases to be included in the survey. The responses of the PA and PCP groups were compared with those of the EP group, and financial charges for care by each group were analyzed.


RESULTS
The EPs tended to follow treatment guidelines closer than did other primary care specialists. The management of PCPs and PAs differed from that of EPs, as follows: [table: see text]


CONCLUSIONS
The EPs more closely followed clinical guidelines than did the PAs and PCPs for these standardized clinical scenarios. Although the relationship of such theoretical practice to actual practice remains unknown, use of these clinical scenarios may identify intended practice patterns warranting attention.
Hirshberg
A J
AJ
Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA 17033-0850, USA. ahirshbe@nursing.hmc.psu.edu
Holliman
C J
CJ
Wuerz
R C
RC
Chapman
D M
DM
D000328:Adult; D001249:Asthma / Q000628:therapy; D001416:Back Pain / Q000628:therapy; D019090:Case Management / Q000592:standards*; D003556:Cystitis / Q000628:therapy; D004635:Emergency Medicine / Q000706:statistics & numerical data*; D005334:Fever / Q000628:therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D010414:Pennsylvania; D010612:Pharyngitis / Q000628:therapy; D010823:Physician Assistants / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic