Page 99 - Encyclopedia of Nursing Research

66 n CLInICAL PREvEnTIvE SERvICES

have reported that nurse practitioners (nPs) therapeutic services, and played a larger role
provide more preventive care than do phy- in ob-gyn clinics than Pas.
C sicians (Hooker & McCaig, 2001); however, Studies using other techniques, such
no studies to date have solely investigated as chart review and vignettes, have also
the factors that may influence the delivery revealed differences between MDs and nPs
rates of clinical preventive services provided in the practice characteristics carried out
by nPs based on the theoretical literature. during patient encounters. In a chart review
Studies that examined the delivery of clini- study comparing nPs and MDs in the pri-
cal preventive services have been conducted mary care of adults with type 2 diabetes,
exclusively with physicians or have included nPs were found to be more likely than MDs
nPs under an umbrella term of “clinicians” to document the provision of general diabe-
dominated by physicians and examined tes education and education about nutrition,
under a medical practice model. weight, exercise, and medications (Lenz et al.,
There is a growing body of evidence that 2002). In a review of 10 health maintenance
nPs and physicians differ in the preventive items, relatively poor overall compliance was
and treatment strategies they use during found with rectal examinations, pneumococ-
patient encounters and in the populations cal vaccinations, and fecal occult blood tests.
served (Aparasu & Hegge, 2001; Hopkins, Better performance was seen for cholesterol
Lenz, Pontes, Lin, & Mundinger, 2005; Lenz, screening and mammography. Patients in
Mundinger, Hopkins, Lin, & Smolowitz, this study who were followed by nPs experi-
2002; Lin, Hooker, Lenz, & Hopkins, 2002; enced better rates of adherence to prevention
Moody, Smith, & Glenn, 1999; Pieper & measures than patients followed by nP-MD
Dinardo, 2001). For example, the process of teams, or MDs alone, although all groups had
nP and MD patient encounters and the pop- relatively low adherence to prevention guide-
ulations these providers tend to serve have lines (Pieper & Dinardo, 2001). Inconsistent
been examined in several studies using data adherence to diabetes guidelines has been
from the national Ambulatory Medical Care found for nPs studied in isolation (Fain
Survey (nAMCS). one study found that nPs & Melkus, 1994) as well as MDs (Puder &
directly supervised by MDs saw younger Keller, 2003).
patients than MDs and provided counseling A study by the national Alliance of
and education during a higher proportion of nurse Practitioners was conducted in 1992
visits (Crabtree et al., 2006; Hooker & McCaig, to evaluate nPs’ performance in the deliv-
2001; Hung et al., 2006). Another study exam- ery of clinical preventive services (Martin,
ined patient encounters of nPs combined 1992). Two journal articles reported conflict-
with physicians’ assistants (PAs) and found ing results of the national Alliance of nurse
that nP/PA patients were more likely to be Practitioners study. one study reported that
65 years or older, female, Black, and from the nationally nPs were meeting or exceed-
northeastern United States when compared ing most of the preventive service objec-
with MD patients (Aparasu & Hegge, 2001). tives (12 out of 17) recommended in Healthy
Another study that used nAMCS data found People 2000, with progress needed in only
nPs to have younger clients who were more a few areas (Lemley, o’Grady, Raukhorst,
often female. nPs also tended to provide Russell, & Small, 1994).
more health counseling interventions and Another study suggested that nPs
to perform fewer office surgical procedures have not been as consistent or as frequent
(Moody et al., 1999). Lin et al. (2002) used in providing preventive services as recom-
nAMCS data to compare nP with PA prac- mended by Healthy People 2000 and major
tice and found that nPs saw a larger propor- authorities (Griffith, 1994). In fact, a later
tion of visits, provided more preventive and study reported nPs devoted less than 1% of