HealthDay News –  A recent study published in the Annals of Internal Medicine suggests that ‘low-value’ health care services, including certain CT or MRI radiographs and referral requests to diagnose and treat backache, headache, and upper respiratory tract infections, were made equally as often by physicians and advanced practice clinicians (APCs). These results suggest that APCs and physicians provided the same amount of low-value health services. 

John Mafi, MD, MPH, from the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues compared the use of low-value services among U.S. APCs and physicians for the 3 specified conditions: upper respiratory infections, back pain, and headache). 

After adjustment for patient and provider characteristics and year, service use after primary care visits was assessed. Data were included for 12 170 physician and 473 APC office-based visits and for 13 359 physician and 2 947 APC hospital-based visits.

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The researchers found that, compared with hospital-based physicians, hospital-based APCs saw younger patients and practiced in urban settings less frequently; office-based clinicians saw similar patients. In both settings, APCs ordered antibiotics, computed tomography and magnetic resonance imaging, radiography, and referrals as often as physicians in unadjusted and adjusted analyses. 

In the hospital-based setting, self-identified primary care provider APCs ordered more services than primary care provider physicians.

Summary and Clinical Applicability

“APCs and physicians provided an equivalent amount of low-value health services, dispelling physicians’ perceptions that APCs provide lower-value care than physicians for these common conditions,” the authors write.

Limitations and Disclosures

Data drawn from the National Ambulatory Medical Care Survey may underrepresent office-based APCs whereas data retrieved from the National Ambulatory Medical Care Survey reflects only hospital-based APC care.

One author disclosed financial ties to the pharmaceutical industry.


Mafi JN, Wee CC, Davis RB, Landon BE. Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians. Ann Intern Med. 2016; Published online  ahead of print June 21,  2016 doi:10.7326/M15-2152