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Determinants of primary care physicians' referral pattern: a structural equation model approach
Kyusuk Chung1, Duckhye Yang, Jun Hyup Lee
1Department of Health Administration, College of Health Professions, Governors State University, University Park, IL 60466-097, USA, ,
International Journal of Public Policy
|March 31, 2010
Summary
Primary care physicians (PCPs) utilizing nurse practitioners and physician assistants (NP-PAs) are more likely to manage complex patients, reducing specialist referrals. NP-PAs enhance PCPs
Area of Science:
- Health Services Research
- Primary Care Medicine
- Healthcare Workforce Studies
Background:
- Primary care physicians (PCPs) face increasing demands, including managing complex patient conditions and navigating managed care.
- The integration of advanced practice providers, such as nurse practitioners and physician assistants (NP-PAs), is a growing trend in primary care.
- Understanding the impact of NP-PAs on physician referral patterns and patient care complexity is crucial for healthcare system efficiency.
Purpose of the Study:
- To investigate how the presence of NP-PAs in PCP practices influences patient referral rates.
- To examine the relationship between managed care, NP-PA utilization, patient complexity, and referral decisions.
- To assess whether NP-PAs enable PCPs to manage more complex cases effectively.
Main Methods:
- Utilized data from the Robert Wood Johnson Foundation Community Tracking Study (CTS) Physician Survey (1996-97 and 1998-99).
- Employed structural equation modeling with binary dependent variables to analyze relationships.
- Examined factors including managed care, NP-PA use, patient condition complexity, and referral numbers.
Main Results:
- PCPs with NP-PAs demonstrated a higher likelihood of treating complex patients rather than referring them.
- Managed care elements influenced PCP referrals primarily through the increased utilization of NP-PAs.
- PCPs with NP-PAs effectively managed complex patients, indicating appropriate care delivery.
Conclusions:
- NP-PAs empower PCPs to focus on patients with complex conditions, thereby reducing the overall number of referrals.
- The integration of NP-PAs positively impacts the gatekeeper role of PCPs within managed care systems.
- NP-PAs contribute to efficient patient management and potentially improve access to specialized care for those most in need.
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