- Research in Gerontological Nursing
- July 2012 - Volume 5 · Issue 3: 163-173
The purpose of this research was to examine factors associated with the use of advanced practice nurse and physician assistant (APN/PA) visits to nursing home (NH) patients compared with those by primary care physicians (PCPs). This was a secondary analysis using Medicare claims data. General estimation equations were used to determine the odds of NH residents receiving APN/PA visits. Ordinary least squares analyses were used to examine factors associated with these visits. A total of 5,436 APN/PAs provided care to 27% of 129,812 residents and were responsible for 16% of the 1.1 million Medicare NH fee-for-service visits in 2004. APN/PAs made an average of 33 visits annually compared with PCPs (21 visits). Neuropsychiatric and acute diagnoses and patients with a long-stay status were associated with more APN/PA visits. APN/PAs provide a substantial amount of care, but regional variations occur, and Medicare regulations constrain the ability of APN/PAs to substitute for physician visits.
Dr. Bakerjian is Assistant Adjunct Professor and Vice Chair, Family and Community Medicine for FNP/PA Studies, Betty Irene Moore School of Nursing, and Dr. Harrington is Professor Emeritus, Sociology and Nursing, Department of Social and Behavioral Sciences, University of California, Davis, Sacramento, California.
The authors have disclosed no potential conflicts of interest, financial or otherwise. Dr. Bakerjian acknowledges the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Scholarship Program for its generous financial support. She also thanks Drs. Jeanie Kayser-Jones, Martin Kitchener, Joseph Mullan, and Steven Paul for their valuable comments and suggestions for the research.
Address correspondence to Debra Bakerjian, PhD, RN, FNP, Assistant Adjunct Professor, Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street, Suite 4202K, Sacramento, CA 95817; e-mail: firstname.lastname@example.org.
Received: June 03, 2010
Accepted: August 01, 2011
Posted Online: June 15, 2012