Nurses, Physician Assistants as Good as Doctors for HIV Care

A study of 68 U.S. HIV clinics found that physician assistants and nurse practitioners provided a quality of care comparable to that of doctors who specialize in HIV/AIDS and they generally outperformed non-specialist doctors.

As part of their education and training, nurse practitioners (NPs) and physician assistants (PAs) learn how to diagnose and treat patients. While NPs and PAs have long been an important part of HIV care, "almost nothing" was known about how well they perform in the role of central caregiver, explained Dr. Ira B. Wilson of Tufts-New England Medical Center in Boston, the study's lead author.

Wilson and colleagues examined medical records for 6,651 HIV patients using eight quality-of-care measures, including the use of HAART, and preventive services such as flu shots and screening for hepatitis C, tuberculosis and cervical cancer. On most of these measures, NPs and PAs offered a quality of care similar to that of physicians specializing in HIV, and better than that of general doctors. On two measures, PAs and NPs outperformed HIV specialists.

However, Wilson noted that there are some "preconditions" to receiving high-quality care from an NP or PA. In particular, they should specialize in treating HIV; have considerable practical experience; and have easy access to a physician with expertise in HIV. About half the study patients who primarily saw a PA or NP were also treated by a doctor at some point during the year.

The authors also cautioned against interpreting the study's findings in terms of "who's better," especially when it comes to chronic diseases like HIV, which is best managed by a team of health care providers. "This is a message about training, expertise and teamwork," Wilson said.

The findings, said Wilson, are especially relevant to rural and inner-city areas of the United States, where there are often doctor shortages, as well as in developing nations hard hit by HIV/AIDS.

The study, "Quality of HIV Care Provided by Nurse Practitioners, Physician Assistants, and Physicians," was published in the Annals of Internal Medicine (2005;143(10):729-736).

Back to other news for November 23, 2005