Wednesday, April 25, 2007

Nurse Practitioners as good as Docs, maybe better

Link
1316 patients who had no regular source of care and kept their initial primary care appointment were enrolled and randomized with either a nurse practitioner (n = 806) or physician (n = 510). ... No significant differences were found in patients' health status ... at 6 months ... hypertension ... was statistically significantly lower for nurse practitioner patients (82 vs 85 mm Hg; P = .04). No significant differences were found in health services utilization after either 6 months or 1 year. There were no differences in satisfaction ratings following the initial appointment (P = .88 for overall satisfaction). Satisfaction ratings at 6 months differed for 1 of 4 dimensions measured (provider attributes), with physicians rated higher (4.2 vs 4.1 on a scale where 5 = excellent; P = .05).
But docs are taught more medicine than nurses; why are they no better at primary care? Probably because docs are famously overconfident. For example, one study found that on average when docs were 88% confident that their patient had pneumonia, in fact only 20% of such patients had pneumonia. And overconfidence is fatal in primary care.