11 Jul More Appointments with Advanced Care Practitioners Linked to Medicaid Expansion
MedicalResearch.com Interview with:
Molly Candon PhD
Research Assistant Professor of Psychiatry
Lecturer, Department of Health Care Management
The Wharton School, University of Pennsylvania
Co-Instructor, Health Services and Policy Research Methods II, MS in Health Policy Research Program, Perelman School of Medicine, University of Pennsylvania
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A team of researchers (led by Karin Rhodes, MD and Dan Polsky, PhD) conducted a secret shopper study of thousands of primary care practices across 10 states, with trained callers simulating patients with Medicaid and requesting appointments.
One of the outcome measures was whether an appointment was scheduled with a physician or Advanced Practitioner. Between 2012 and 2016, the share of appointments scheduled with Advanced Practitioners increased by five percentage points.
MedicalResearch.com: What should readers take away from your report?
Response: Over the same time period, appointment availability for Medicaid patients also increased by five percentage points. While we cannot determine a causal pathway between AP utilization and primary care access with these data, our findings show that Advanced Practitioners are playing a larger role in primary care delivery, which may help explain why appointment availability increased despite millions of new Medicaid beneficiaries.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: This was a study of access, so more research is needed to understand how practices are harnessing Advanced Practitioners and, in turn, how Advanced Practitioners are impacting both physicians and patients. Researchers should also focus on Advanced Practitioner utilization in medically underserved areas and how scope of practice is driving workforce allocation.
MedicalResearch.com: Is there anything else you would like to add?
Response: There is a fairly robust literature demonstrating that Advanced Practitioners do not deliver lower-quality care compared to primary care physicians. However, these studies can reinforce the notion that physicians and APs are substitutes—there is plenty of work to go around! Instead, we should envision a team-based approach that uses both physicians and APs to their full capabilities in order to increase access, maintain quality, and reduce costs.
Lena Leszinsky and Molly Candon
Annals Journal Club: Primary Care Appointments for Medicaid Beneficiaries With Advanced Practitioners Ann Fam Med July/August 2019 17:363-366; doi:10.1370/afm.2399
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