Diagnosing Depression: The Role of Physician Assistants and Nurse Practitioners

Background/purpose: Expansion of services delivered by physician assistants (PA) and nurse practitioners (NP) has been suggested as a solution for meeting the anticipated increased demand for health services. Yet, little is known about the role these providers play in the delivery of depression services within primary care. This study examined the relationship between provider type and the diagnosis of depression in primary care visits in the US.

Methods/approach: Primary care visits from the 2004-2010 National Ambulatory Medical Care Survey, a nationally representative sample of outpatient office visits, were analyzed. Survey-adjusted multivariate logistic regression was used to examine the independent contribution of the type of provider seen (Physician vs PA/NP only) on the likelihood of having a new depression diagnosis, defined as a visit for a new problem with depression identified as the primary diagnosis.

Findings: 96.4% of the 8,253,097 (weighted, unweighted n= 232) primary care visits with a new depression diagnosis were attended by physicians compared to a 98.4% for all visits. Logistic regression results showed an increased likelihood of having a visit with a new depression diagnosis when the visit was attended by a PA or NP only (OR=2.1; 95% CI = 0.87-4.9); however, this finding was not statistically significant (p = 0.10).

Implications: These findings suggest that when given the opportunity, PAs and NPs are playing an active role in the recognition of depression within primary care visits. Increased utilization of these providers may improve access to depression care.