Is provider type associated with cancer screening and prevention: advanced practice registered nurses, physician assistants, and physicians.

Deanna Kepka,K Robin Yabroff,Christopher Zeruto,Alexandria Smith

doi:10.1186/1471-2407-14-233

Abstract

BackgroundPhysician recommendations for cancer screening and prevention are associated with patient compliance. However, time constraints may limit physicians’ ability to provide all recommended preventive services, especially with increasing demand from the Affordable Care Act in the United States. Team-based practice that includes advanced practice registered nurses and physician assistants (APRN/PA) may help meet this demand. This study investigates the relationship between an APRN/PA visit and receipt of guideline-consistent cancer screening and prevention recommendations.MethodsData from the 2010 National Health Interview Survey were analyzed with multivariate logistic regression to assess provider type seen and receipt of guideline-consistent cancer screening and prevention recommendations (n = 26,716).ResultsIn adjusted analyses, women who saw a primary care physician (PCP) and an APRN/PA or a PCP without an APRN/PA in the past 12 months were more likely to be compliant with cervical and breast cancer screening guidelines than women who did not see a PCP or APRN/PA (all p < 0.0001 for provider type). Women and men who saw a PCP and an APRN/PA or a PCP without an APRN/PA were also more likely to receive guideline consistent colorectal cancer screening and advice to quit smoking and participate in physical activity than women and men who did not see a PCP or APRN/PA (all p < 0.01 for provider type).ConclusionsSeeing a PCP alone, or in conjunction with an APRN/PA is associated with patient receipt of guideline-consistent cancer prevention and screening recommendations. Integrating APRN/PA into primary care may assist with the delivery of cancer prevention and screening services. More intervention research efforts are needed to explore how APRN/PA will be best able to increase cancer screening, HPV vaccination, and receipt of behavioral counseling, especially during this era of healthcare reform.

Highlights

Physician recommendations for cancer screening and prevention are associated with patient compliance
Ageeligible women were more likely to receive Pap screening if they saw a primary care physicians (PCP) and an APRN/Physician Assistant (PA) (90.0%) or PCP and no APRN/PA (85.6%) compared to those who saw another type of healthcare provider (67.7%) or no healthcare provider (66.8%)
Women were more likely to receive a mammogram if they saw a PCP and an APRN/PA (74.0%) or PCP and no APRN/PA (74.6%) compared to those who saw another type of healthcare provider (53.5%) or no healthcare provider (49.3%)

Summary

Introduction

Physician recommendations for cancer screening and prevention are associated with patient compliance. Under the Affordable Care Act, Medicare and new health insurance plans and policies must cover selected evidence based preventive services without co-insurance, cost sharing, a copayment or contributions towards a deductible. In team-based practice settings, advanced practice registered nurses and physician assistants (APRN/PA) may help meet this demand for primary care. This approach has been suggested for improved organization of practice systems for chronic disease management since the 1980’s [5,6]. Physician assistants practice medicine alongside a physician supervisor with a similar scope of practice

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