Non-Physician Providers, Cancer Screening and Health Behavior Counseling

Abstract

Abstract Purpose: Patients who receive a physician's recommendation for cancer screening and behavioral modification are most likely to comply with these recommendations. However, physicians face time constraints that make it nearly impossible to provide all recommended preventive services. The 2010 Affordable Care Act will expand health insurance coverage to 42 million Americans by 2014. Non-physician providers may help meet this new demand for primary care and ensure compliance with preventive services recommendations. Methods: Data from the 2005 National Health Interview Survey were analyzed using multivariate logistic regression to assess the association between provider type seen in the past 12 months and compliance with U.S. Preventive Services Task Force cancer screening recommendations and receipt of behavior counseling among age-eligible adults (n = 23,201). Models were adjusted for age, level of education, and insurance status and stratified by gender. Results: About 15% of NHIS participants (N = 4,652) saw a non-physician provider (nurse practitioner, certified nurse midwife or physician assistant) and a primary care physician. In adjusted analyses, age-eligible women were more likely to be compliant with Pap screening (OR: 5.0; 95% CI: 4.2–5.9), mammography (OR: 6.6; 95% CI: 5.2–8.4) and colorectal screening recommendations (OR: 7.8; 95% CI: 5.3–11.4) if they saw a non-physician provider and a primary care physician compared to not seeing any provider. Similarly, men were more likely to be compliant with colorectal screening recommendations (OR: 9.6; 95% CI: 6.9–13.5) if they saw a non-physician provider and a primary care physician. Women and men were more likely to report a provider asking about smoking status if they saw a non-physician provider and a primary care physician than those who saw other types of healthcare providers ((OR: 2.2; 95% CI: 2.0–2.4) and (OR: 3.0; 95% CI: 2.4–3.7), respectively). Conclusions: Seeing a non-physician provider and a primary care physician is related to an increased likelihood of compliance with cancer screening recommendations and receipt of health behavior counseling. Opportunities exist for non-physician providers during this era of healthcare reform.