Table 3 Studies of Advanced Practices Registered Nurses and Physician Assistants (APRN/PA) and breast, cervical and colorectal cancer screening
Study | Sample size | Outcome measure | Setting and study design | Pap findings | Mammogram findings | Colorectal cancer screening findings |
|---|---|---|---|---|---|---|
Menees et al., [24] | Total providers: 336 OB/GYNS: 182 | Self-Report of MDs and NPs | National survey of OB/GYNs and NPs | Pap test routinely provided: | Mammography routinely recommended: | CRC screening routinely recommended: |
NPs: 94.8% | NPs: 90.9% | NPs: 61.7% | ||||
Cross sectional Survey | ||||||
NPs: 154 | OB/GYNs: 97.8% | OB/GYNs: 98.9% | OB/GYNs: 87.2% | |||
P < 0.01 | P < 0.01 | P < 0.01 | ||||
Unadjusted | Unadjusted | Most common CRC screening recommended by either provider: | ||||
FOBT: 76.2% | ||||||
Colonoscopy: 28.3% | ||||||
P-value not reported | ||||||
Ordered colonoscopy: | ||||||
NPs: 19.8% | ||||||
OB/GYNs: 37% | ||||||
P < 0.005 | ||||||
All measures unadjusted | ||||||
Hopkins et al., [26] | Total patients: 1339 | Chart review | Chart review in private practice | Receipt of Pap test: | Receipt of mammogram: (Aged 40+) | Patient receipt of colorectal screening: (Ages 50 +) |
PHCC NP patients: 755 | and primary care health centers in New York City | PHCC NPs: 71.5% | PHCC NPs: 69% | PHCC NPs: 19.1% | ||
PHCC MDs: 53.8% | PHCC MDs: 64.2% | PHCC MDs: 45.7% | ||||
MD patients: 441 | Retrospective cohort | P < 0.001 | P = 0.240 | P < 0.001 | ||
PP NP patients: 143 | Unadjusted | Unadjusted | Unadjusted | |||
Sansbury et al., [28] | Total providers: 1900 | Self-Report of MDs about APRN/PAs | National survey of MDs | NA | NA | Work with NP/PA to provide FOBT: |
PC MDs: 1235 | Cross sectional survey | Â | Â | MDs report working with a NP or PA to provide FOBT: 23.8% | ||
NPC MDs: 665 | ||||||
Of the 24% of physicians who work with NP/PA for FOBT, they reported frequency of supervising a NP or PA for FOBT: | ||||||
Supervised a NP: 75% | ||||||
Supervised a PA: 25% | ||||||
P-value not reported for all measures | ||||||
All measures unadjusted | ||||||
Oliveria et al., [29] | Total providers: 1363 | Self-Report of MDs about APRN/PAs | National survey of MDs | MDs amenable to NP/PA screening: | NA | NA |
MDs: 1363 | Cross sectional survey | Team Practice^: 89.6% | ||||
Non-team Practice^^: 59.9% | ||||||
Team vs Non-team of amenable MDs: | ||||||
OR = 8.11 (95% CI: 5.80–11.35) | ||||||
P = 0.001 | ||||||
MDs reporting NP/PA screening: | ||||||
All MDs reporting frequency of NPs or PAs performing Pap tests: | ||||||
NPs: 33.5% | ||||||
PAs: 23.2% | ||||||
Team practice MDs reporting frequency of NP/PA performing Pap tests: | ||||||
NPs: 89.3% | ||||||
PAs: 82.7% | ||||||
P-value not reported for all other measures | ||||||
All measures unadjusted | ||||||
Shaheen et al., [30] | Total providers: 1784 | Self-Report of APRN/PAs | Survey of NPs and PAs in North Carolina | NA | NA | NP/PA who recommend/perform FOBT: |
Total NPs: 526 | Cross sectional survey | Primary Care PA: 94.6% | ||||
Total PAs: 640 | Primary Care NP: 92.1% | |||||
PC PAs: 322 | NP/PA who recommend/perform flexible sigmoidoscopy: | |||||
PC NPs: 270 | ||||||
Primary Care PA: 76.1% | ||||||
Primary Care NP: 69.2% | ||||||
P-value not reported | ||||||
Unadjusted | ||||||
Murphy, [31] | Total providers: 346 | Self-Reportof CNMs | National survey of CNMs | 98% of CNMs report they routinely provide pap tests to 81-100% of their gynecologic patients | NA | NA |
CNMs: 346 | Cross sectional survey | |||||
P-value not reported | ||||||
Unadjusted | ||||||
Mandelblatt et al., [39] | Total patients: 319 | Chart review | Two New York City study hospitals with NP led intervention and usual care control | Receipt of Pap test in intervention group: | Receipt of mammography in intervention group: | NA |
Intervention: 160 | ||||||
Baseline: 17.8% | Baseline: 18.3% | |||||
Control: 159 | ||||||
Total providers: Not Reported | ||||||
Intervention | Post: 56.9% | Post: 40% | ||||
P < 0.01 | P < 0.01 | |||||
Receipt of Pap test in control group: | Receipt of mammography in control group: | |||||
Baseline: 11.8% | Baseline: 18.1% | |||||
Post: 18.2% | Post: 18.2% | |||||
P-value not reported | P-value not reported | |||||
All measures unadjusted | All measures unadjusted |