title: Primary care physician assistant and advance practice nurses roles: Patient healthcare utilization, unmet need, and satisfaction.
abstract: OBJECTIVE
  Team-based care involving physician assistants (PAs) and advance practice nurses (APNs) is one strategy for improving access and quality of care. PA/APNs perform a variety of roles on primary care teams. However, limited research describes the relationship between PA/APN role and patient outcomes. We examined multiple outcomes associated with primary care PA/APN roles.
  
  
  METHODS
  In this cross-sectional survey analysis, we studied adult respondents to the 2010 Health Tracking Household Survey. Outcomes included primary care and emergency department visits, hospitalizations, unmet need, and satisfaction. PA/APN role was categorized as physician only (no PA/APN visits; reference), usual provider (PA/APN provide majority of primary care visits) or supplemental provider (physician as usual provider, PA/APN provide a subset of visits). Multivariable logistic and multinomial logistic regressions were performed.
  
  
  RESULTS
  Compared to people with physician only care, patients with PA/APNs as usual providers [5-9 visits RRR=2.4 (CI 1.8-3.4), 10+ visits RRR=3.0 (CI 2.0-4.5): reference 2-4 visits] and supplemental providers had increased risk of having 5 or more primary care visits [5-9 visits RRR=1.3 (CI 1.0-1.6)]. Patients reporting PA/APN as supplemental providers had increased risk of emergency department utilization [2+ visits: RRR 1.8 (CI 1.3, 2.5)], and lower satisfaction [very dissatisfied: RRR 1.8 (CI 1.03-3.0)]. No differences were seen for hospitalizations or unmet need.
  
  
  CONCLUSIONS
  Healthcare utilization patterns and satisfaction varied between adults with PA/APN in different roles, but reported unmet need did not. These findings suggest a wide range of outcomes should be considered when identifying the best PA/APN role on primary care teams.
authors.affiliation: Physician Assistant Program, Department of Community and Family Medicine, Duke University School of Medicine, 800 South Duke Street, Durham, NC 27701, United States. Electronic address: christine.everett@duke.edu.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Everett
authors.affiliation: Physician Assistant Program, Department of Community and Family Medicine, Duke University School of Medicine, 800 South Duke Street, Durham, NC 27701, United States. Electronic address: perri.morgan@duke.edu.
authors.forename: Perri
authors.initials: P
authors.lastname: Morgan
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center and Division of General Internal Medicine, Duke University School of Medicine, United States. Electronic address: george.l.jackson@duke.edu.
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D009722:Nurse Practitioners; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D010823:Physician Assistants; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care / Q000458:organization & administration*; D024382:Professional Role; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Advanced practice nurse; Physician assistant; Primary care; Role