Comparing Services Ordered by Advanced Practice Clinicians and Physicians

HealthDay News — Advanced practice clinicians (APCs) and physicians order low-value health services with similar frequency, according to a study published online June 20 in the Annals of Internal Medicine.1

John Mafi, MD, MPH, from the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues compared the use of low-value services among US APCs and physicians for three conditions (upper respiratory infections, back pain, and headache). After adjustment for patient and provider characteristics and year, service use after primary care visits was assessed. Data were included for 12,170 physician and 473 APC office-based visits and for 13,359 physician and 2,947 APC hospital-based visits.

The researchers found that, compared with hospital-based physicians, hospital-based APCs saw younger patients and practiced in urban settings less frequently; office-based clinicians saw similar patients. In both settings, APCs ordered antibiotics, computed tomography and magnetic resonance imaging, radiography, and referrals as often as physicians in unadjusted and adjusted analyses. In the hospital-based setting, self-identified primary care provider APCs ordered more services than primary care provider physicians.

“APCs and physicians provided an equivalent amount of low-value health services, dispelling physicians’ perceptions that APCs provide lower-value care than physicians for these common conditions,” the authors write.

One author disclosed financial ties to the pharmaceutical industry.


1.Mafi JN, Wee CC, Davis RB, Landon BE. Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians. Ann Intern Med. 2016.