Patient Safety and Quality

Experienced nurse practitioners and physician assistants provide high-quality care for people with HIV

About 20 percent of patients cared for in HIV clinics receive most of their HIV care from nurse practitioners (NPs) and physician assistants (PAs). Under certain circumstances, these NPs and PAs provide HIV care similar to that of physician HIV experts and infectious disease physicians, and better care than generalist physicians who are not HIV experts. According to a study supported in part by the Agency for Healthcare Research and Quality (HS10227), NPs and PAs who provide this level of HIV care have extensive HIV experience and usually follow an average of 10 HIV patients at a time. They also typically practice in clinics with several supports for HIV care, including HIV care teams and access to expert HIV physicians.

Researchers surveyed 243 clinicians (177 physicians and 66 NPs and PAs) at 68 HIV care sites in 30 different States. They reviewed the medical records of 6,651 persons with HIV or AIDS over a 1-year period to examine their quality of care. NP and PA performance on eight quality measures of HIV care were similar to or better than physicians, even after controlling for patient and HIV clinic characteristics.

For example, rates of highly active antiretroviral therapy (HAART) use for eligible patients, control of viral load for patients receiving HAART, flu vaccine use, and number of outpatient monitoring visits were higher for NPs and PAs than for generalist non-HIV experts and were similar to infectious disease-trained physicians and generalist HIV experts. Rates of prophylaxis for Pneumocystis carinii pneumonia (that often occurs with impaired immune function) and hepatitis C testing did not differ significantly between groups. However, NPs and PAs performed more tuberculosis and cervical cancer screening tests than all three groups of doctors.

More details are in "Quality of HIV care provided by nurse practitioners, physician assistants, and physicians," by Ira B. Wilson, M.D., M.Sc., Bruce E. Landon, M.D., M.B.A., Lisa R. Hirschhorn, M.D., M.P.H., and others in the November 15, 2005, Annals of Internal Medicine 143, pp. 729-736.

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