Background/Purpose: A recent workforce study of rheumatology in the US suggests that during the next several decades the demand for rheumatology services will outstrip the supply of rheumatologists. Mid-level providers working in rheumatology, such as nurse practitioners (NPs) and physician assistants (PAs), may be able to alleviate projected shortages, but national data on their current roles and responsibilities are sparse.
Methods: We administered a nation-wide survey to mid-level rheumatology providers during 2012 through the Association of Rheumatology Health Professionals and Society of Physician Assistants in Rheumatology. E-mails and mailed invitations with the survey were sent with one follow-up reminder. The survey contained questions regarding demographics, training, level of practice independence and responsibilities, disease modifying anti-rheumatic drug (DMARD) prescribing, use of objective RA outcome measures, and knowledge and use of Treat to Target strategies.
Results: The invitation was sent to 482 eligible mid-level providers via e-mail and 90 via US mail. We received a total of 174 (30%) responses, 47% from NPs and 51% from PAs (2% missing). The mean age was 46 (±11) years, and 83% were female. Nearly 75% had ≤10 years of experience, and 53% received formal training in rheumatology training. Sixty-three percent reported having their own panel of patients. Respondents reported seeing patients in the context of follow-up visits (98%), initial consults (74%), and urgent visits (89%). They described a variety of practice responsibilities, with the top five being: performing patient education (98%), adjusting medication dosages (97%), conducting physical exams (96%), treating patients (96%), and starting patients on medications (94%). Over 90% felt very or somewhat comfortable diagnosing RA and a similar percentage prescribed DMARDs (see Table). Forty-nine percent reported using DAS, CDAI, SDAI, and/or RAPID disease activity measures for RA and 56% reported that their practices used Treat to Target strategies.
Conclusion: Most NPs and PAs responding reported substantial patient care responsibilities, working independently; many reported using disease activity measures and treat to target strategies. These data suggest the potential opportunity of expanding the use of NPs and PAs as practitioners in rheumatology to reduce the projected workforce shortages and meet current RA treatment recommendations.
Table: Survey Responses
|
|
Total |
|
Confidence diagnosing RA1 |
|
|
Very confident |
76.9% |
|
Somewhat confident |
21.3% |
|
Not particularly confident |
1.2% |
|
Not at all confident |
0.6% |
|
Manages patient treatment2 |
|
|
Yes |
94.6% |
|
No |
5.4% |
|
Knows of TTT2 |
|
|
Yes |
77.8% |
|
No |
22.2% |
|
Practice uses TTT3 |
|
|
Yes |
75.4% |
|
No |
24.6% |
|
Outcomes measures used4 |
|
|
DAS |
21.5% |
|
CDAI |
12.8% |
|
SDAI |
0.6% |
|
HAQ |
37.8% |
|
RAPID |
23.3% |
|
Patient global |
25.0% |
|
Physician global |
21.5% |
|
Uses any outcomes measure |
48.6% |
Abbreviations: DAS = Disease Activity Score; CDAI = Clinical
Disease Activity Index; SDAI = Simple Disease Activity Index;
HAQ = Health Assessment Questionnaire; RAPID = Routine
Assessment of Patient Index Data; TTT = Treat to Target
Totals varied due to missing data:
1N = 169; 2N = 167; 3N = 130; 4N = 172
Disclosure:
E. Brown,
None;
A. Bitton,
None;
L. Fraenkel,
None;
H. Tsao,
None;
J. N. Katz,
None;
D. H. Solomon,
Lilly, Amgen, CORRONA,
2,
Lilly, Novartis, BMS, Pfizer,
6,
Lilly, BMS, Novartis,
9.
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