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Tuesday, January 8, 2013

Serving Patients with Alternatives Health Providers

A recent New York Times editorial explored the exciting potential of allowing alternative health providers give patients routine care. This step could help meet the growing demand for primary care services as we face a shortage of primary care physicians in many areas. And, it could save both consumers and the health system money.

The article refers to alternative health providers as “non-doctors,” such as nurse practitioners, physician assistants, pharmacists, and even community members and the patients themselves, who can help provide care. Typically, these providers can give routine care that is less expensive per visit. This saves money, and it increases access in areas that are suffering from a primary care physician shortage.

Here’s a brief list of some of the non-doctors that the editorial highlights and the care they can help provide:

  • Pharmacists: The care that pharmacists, who have extensive education and capabilities, provide is often limited by state laws. But in the Department of Veterans Affairs, for example, pharmacists can perform services such as adjusting medication, ordering laboratory tests, and coordinating follow-ups. Allowing pharmacists to perform these services would reduce the need for primary care physicians to do these tasks.  
  • Community Aides: Community members in Houston, Texas, and Harrisonburg, Virginia, have been trained to deliver some pediatric care as a way to reduce hospital visits and the costs of home care. So far, the results have been promising: It was estimated that there were significant reductions in the number of visits to emergency rooms and the costs of care were substantially lower.
  • Nurse Practitioners:  Nurse practitioners are increasingly being allowed to provide services traditionally reserved to primary care physicians, such as writing prescriptions and diagnosing and treating patients. In fact, studies have shown that nurse practitioners are just as good as doctors at providing this care. However, states need to make laws that explicitly allow for them to provide these services. 
  • Patients: One initiative run by the Vanderbilt University Medical Center has patients enter their blood pressure, glucose levels, etc., online, where a primary care physician reviews the data. The patient can then consult with the physician by phone or email on care procedures, rather than going in for a doctor visit.  

The above are all great examples of both meeting the needs of patients while also driving down health care costs. The Affordable Care Act provides some funding for primary care training, and these novel approaches help to address the problem even further.