Evidence map›Paper›PMID 27456894›Full record

ArticleJournal of primary care & community health2016

Factors Associated With Seeking Physician Care by Medicare Beneficiaries Who Receive All Their Primary Care From Nurse Practitioners.

Michelle Y Raji, Nai-Wei Chen, Mukaila Raji, Yong-Fang Kuo

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of primary care & community health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
0.6field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Michelle Y RajiHarvard College, Harvard University, Cambridge, MA, USA.
Nai-Wei ChenThe University of Texas Medical Branch, Galveston, TX, USA.
Mukaila RajiThe University of Texas Medical Branch, Galveston, TX, USA muraji@utmb.edu.
Yong-Fang KuoThe University of Texas Medical Branch, Galveston, TX, USA.
Harvard University Press · USThe University of Texas Medical Branch at Galveston · US

Funding

UTMB Clinical and Translational Science AwardUL1TR001439 · NCATS · UNIVERSITY OF TEXAS MED BR GALVESTON · PI URBAN, RANDALL J · 2015 to 2024
$40.0M
UTMB OAIC Research Education Component (REC)P30AG024832 · NIA · UNIVERSITY OF TEXAS MEDICAL BR GALVESTON · PI JAMES S. GOODWIN, MD, MELISSA M. MORROW · 2005 to 2026
$26.7M
Patient Centered Outcomes Research in the ElderlyR24HS022134 · AHRQ · UNIVERSITY OF TEXAS MED BR GALVESTON · PI GOODWIN, MD, JAMES S. · 2013 to 2017
$4.8M
Care of the elder hospitalized patient: the role of the hospitalistsR01AG033134 · NIA · UNIVERSITY OF TEXAS MED BR GALVESTON · PI GOODWIN, MD, JAMES S. · 2009 to 2018
$2.2M
Assessing The Role of Nurse Practitioner in Primary Care of Older AdultsR01HS020642 · AHRQ · UNIVERSITY OF TEXAS MED BR GALVESTON · PI KUO, YONG-FANG · 2012 to 2019
$1.4M
AHRQ HHS R01 HS020642AHRQ HHS R24 HS022134NCATS NIH HHS UL1 TR001439NIA NIH HHS P30 AG024832NIA NIH HHS R01 AG033134
6 · The paper itself

Abstract

backgroundA shortage of primary care physicians has led to the alternative strategy of nurse practitioners (NPs) as primary care providers for the growing elderly population. Many states have implemented policies that allow NPs to practice independently with no physician oversight. Little is known about the continuity of primary care provided by NPs.

objectiveTo examine rate and correlates of switching from exclusive NP primary care to receiving some or all primary care from physicians.

designA retrospective cohort study.

participantsMedicare beneficiaries (n = 38 618) with diabetes, congestive heart failure, or chronic obstructive pulmonary disease who received all their primary care from NPs in 2007. MAIN MEASURES: Multivariable logistic regression model was used to assess patient and disease characteristics associated with switching from sole NP primary care in 2007 to receiving some or all primary care from physicians between 2008 and 2010.

resultsOf elderly patients receiving all their primary care from NPs in 2007, 53.8% switched to receiving some or all primary care from physicians in 2008-2010. The switching patients had less comorbidity before the switch and were more likely to reside in metropolitan areas, ZIP code areas with high education or states with the most restriction on NP scope of practice. In multivariable analyses, significant predictors of switching included one of the following within 30 days before the switch: emergency room visits (odds ratio [OR] = 1.55, 95% confidence interval [CI] = 1.44-1.68), hospitalization (OR = 1.13, 95% CI = 1.02-1.25), new diagnosis of heart attacks (OR = 5.52, 95% CI = 4.33-7.02), pneumonia (OR = 4.84, 95% CI = 3.71-6.32), atrial fibrillation (OR = 3.99, 95% CI = 2.93-5.44), stroke (OR = 2.94, 95% CI = 2.31-3.74), or cancer (OR = 2.65, 95% CI = 1.94-3.63).

conclusionsAbout half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period. Future study is needed to understand the reasons for switching.

Indexed as

Nurse PractitionersAgedAged, 80 and overComorbidityContinuity of Patient CareFemaleHumansMaleMedicareMultivariate AnalysisPractice Patterns, Physicians'Primary Health CareResidence CharacteristicsRetrospective StudiesRisk FactorsUnited Statesdiscontinuity of careMedicarenurse practitionerprimary care

Identifiers

PMID27456894
PMCPMC5544433
OpenAlexW2480813690

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.