Practice patterns and patient-reported outcomes of care are compared in detail for ten physicians and 12 new health practitioners delivering ambulatory care in two departments of a prepaid group practice, the Columbia Medical Plan (CMP). All providers completed questionnaires for a 50 per cent random sample of patients seen during a two-week period. Patients completed questionnaires prior to receiving care and were interviewed one week and one month after their clinic visits. New health practitioners deliver approximately 75 per cent of well-person care, 56 per cent of problem-oriented care in adult medicine, and 29 per cent of problem care in pediatrics. They have become increasingly involved over time in the treatment of acute conditions and injuries while physicians have retained their predominant role in treating patients with chronic conditions. Thirty-two per cent of visits with new healh providers involved a physician in one or more of the following: decision-making, direct supervision, consultation, or seeing the patient as a second provider of care. Degree of autonomy varied by type of task performed, category of problem treated, and specialty. The following outcomes of care were examined by type of provider: patient-reported change in problem status,including frequency and intensity of pain or discomfort, level of anxiety, and degree of activity limitation; the degree to which physician-specified criteria for the most commonly occurring conditions were met with respect to change in problem status; and patient satisfaction with a number of dimensions of the clinic visit. The analysis suggests that the new health practitioners at the CMP are providing care, within their areas of responsibility, of comparable quality to that delivered by physicians.

The role of new health practitioners in a prepaid group practice: provider differences in process and outcomes of medical care.

The effectiveness of nurse clinicians' service delivery.

The content and emphasis of well-child visits conducted by nine randomly selected pediatricians was compared with those of five experienced pediatric nurse practitioners. Twenty one nurse visits and 43 pediatrician visits with 1-year-old to 2-year-old children were monitored. The nurses discussed developmental and child behavior topics in significantly (P less than .05) greater depth, they asked more open-ended questions, made more specific recommendations, provided more maternal support, and the parents spoke a greater proportion of the time during the nurses' visits. Efficiency (number and depth of topics considered per unit time) of both groups was similar. Nurse visits were more time-consuming (mean, 25.5 vs 17.6 minutes for pediatricians). A subgroup of four pediatricians conducted visits much like those of the nurses, scoring as well in less time. The other five pediatricians conducted shorter visits, with little emphasis on child development and provided less time for the parent to talk. Overall, after five years in practice, these nurses were in no way less complete in child health supervision than a representative sample of pediatricians and were considerably more comprehensive in their approach than the average pediatrician.

Content and Emphasis of Well-Child Visits: Experienced Nurse Practitioners vs Pediatricians

Argues that as psychology has become more intimately involved in addressing society's pressing needs and has begun to conceptualize itself as a health care profession, it has become necessary collectively to rethink earlier self-imposed limits on its fundamental "scope of practice." Under our constitutional framework, psychologists employed within federal and state systems are not bound by the parameters of the various state practice acts, and certain psychologists have been able to demonstrate that, like their colleagues in a wide range of other professions, they can accept the clinical responsibility of utilizing psychoactive medications responsibly. To date, the profession's traditional training institutions have not accepted their responsibility of systematically providing relevant training experiences. Further, there is considerable disagreement within the practice community as to whether the profession should enter the prescription arena. However, recent legislative developments at the federal and s...

The Case for Prescription Privileges: A Logical Evolution of Professional Practice

Marginal malnutrition in school-aged Colombian boys: anthropometry and maturation

Weight, height, and head circumference measurements of 4,167 Spanish-surnamed school-aged children were compared with similar data from 2,322 non-Spanish surnamed children who resided in the same Denver, Colorado neighborhoods. These data were also compared with data from six other studies. Both male and female Spanish-surnamed children were found to weigh less, be shorter, and have smaller head circumferences than non-Spanish-surnamed children living in the same Denver neighborhoods. The sizes of the children in these two populations residing in lower and lower-middle class neighborhoods were closer to each other than to the sizes of children from middle and upper-middle socioeconomic classes as measured in previous studies or to the sizes of children in the recently published cross-sectional National Center for Health Statistics study. Such comparisons suggest that growth retardation is more a reflection of socioeconomic factors than of ethnic-genetic factors.

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.69.9.903

A comparison of growth: Spanish-surnamed with non-Spanish-surnamed children.

Comparison of the physical assessment of children by pediatric nurse practitioners and pediatricians.

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A comparison of growth: Spanish-surnamed with non-Spanish-surnamed children.

Comparison of the physical assessment of children by pediatric nurse practitioners and pediatricians.