Comparing Advanced Practice Providers and Physicians as Providers of e-Visits.

BACKGROUND: Although electronic delivery (electronic visits [e-visits]) of healthcare services by advanced practice providers (APPs) is growing, literature defining the roles of different providers and comparing outcomes is lacking. We analyzed two e-visit models at the University of Pittsburgh Medical Center (UPMC) to compare their providers (physicians and APPs) and associated outcomes.

MATERIALS AND METHODS: We identified all e-visits for the UPMC AnywhereCare Continuity (physician providers for existing patients) and Convenience (physician and APP providers for Pennsylvania residents) services (n=2,184) using Epic Systems (Verona, WI) MyChart data (November 2013-August 2014). We compared e-visits by service and provider type for patient characteristics, volume, response time, primary diagnoses, and number of prescriptions. We used statistical tests to determine differences in patient characteristics and an ordinary least square linear regression, controlling for patient characteristics, to determine differences in prescribing.

RESULTS: Of the completed e-visits (n=1,791), 72.5% were with APPs, and 27.5% were with physicians. APP patients were younger, higher income, and more likely to be unmarried. Sinusitis patients were more likely to use the Continuity service, whereas those with urinary tract or upper respiratory infections were more likely to use the Convenience service. Finally, provider type was significantly associated with prescribing, with APPs prescribing more.

CONCLUSIONS: Some demographic variation exists between users of APP versus physician e-visits. Provider response time seems more driven by service policy than provider type. Finally, variation exists between provider types in quantities of prescriptions written. As health systems and policymakers develop protocols and reimbursement strategies for e-visits, these model considerations will be important.