Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis.

UNLABELLED: BACKGROUND: Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA) has been a frontrunner in the use of nurse practitioners (NPs) and physician assistants (PAs). Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians. METHODS: This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician). RESULTS: NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits. CONCLUSIONS: This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.

A survey of statural changes with age in the adult population of the United States

A study of the patterns of height loss with age in the Anglo, black, and Mexican-American populations of the United States has been undertaken. The study was based on data gathered by the United States Public Health Service in the Second National Health and Nutrition Examination Survey and the Hispanic Health and Nutrition Examination Survey. Estimates of height loss were obtained by subtracting present stature from a calculated maximum attained height derived from sex- and race/ethnic-specific regression equations relating stature to subischial length. Anglo women have greater height losses than Anglo, black, or Mexican-American males, and black or Mexican-American females. Between 24 and 74 years of age, Anglo women average 3.8 cm. loss in stature. The black populations lose less height than Anglos or Mexican-Americans. Mexican-Americans lose less height than Anglos from 24 to 54 years and then have a greatly increased height loss so that by age 74 their total height loss is the same as Anglos. Standing height, sitting height, body mass index, and the Poverty Index were found to be negatively correlated with height loss. Age was positively correlated to height loss. The most important determinants of the magnitude of height loss with age were sex and ethnicity. ^

Healthy people 2000 : public health service action /

Mode of access: Internet.

Organization and staffing for full-time local health services; analysis of information submitted to the Public Health Service in Report of public health personnel as of December 31, 1954.

Mode of access: Internet.

President's Private Sector Survey on Cost Control : report on Department of Health and Human Services, Public Health Service/Health Care Financing Administration.

Mode of access: Internet.

U.S. Public Health Service Commissioned Corps.

4 leaves in pocket.

Manual of recommended practice for sanitary control of the shellfish industry; 1946 recommendations of the Public Health Service.

Mode of access: Internet.

Public Health Service publication.

Mode of access: Internet.

United States Revenue-Cutter Service.

Mode of access: Internet.

The Health consequences of smoking : a Public Health Service review.

Mode of access: Internet.

Drug addiction and the U.S. Public Health Service : proceedings of a symposium commemorating the 40th anniversary of the Addiction Research Center at Lexington, Ky. /

Mode of access: Internet.

Compendium of legally and administratively defined missions of the various research supporting divisions of the Public Health Service; a working draft for administrative purposes.

Mode of access: Internet.

The influence of lighting, eyesight, and environment upon work production. Report of a two-year study made jointly by the Public Buildings Administration and the Public Health Service.

Study made in a card-punch subsection of the Bureau of Internal Revenue.

Report of the Federal Security Agency: Public Health Service.

Reports for 1943/44-1946/47 issued also as part of the publicaiton, Federal Security Agency, Annual report.

Healthy eating in Indian country.

Mode of access: Internet.