(HealthDay News) — Advanced practice clinicians (APCs) use more imaging than primary care physicians (PCPs), according to a study published in JAMA Internal Medicine.

Danny R. Hughes, PhD, from the Harvey L. Neiman Health Policy Institute in Reston, Virginia, and colleagues compared the use of diagnostic imaging ordered by APCs (specifically, nurse practitioners and physician assistants) vs. PCPs following office-based encounters. 

Data were obtained from 2010 to 2011 Medicare claims for a 5% sample of beneficiaries.

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The researchers found that APCs ordered imaging in 2.8% of episodes of care, compared with 1.9% for PCPs. APCs were more likely to order imaging than PCPs in adjusted estimates and across all patient groups and imaging services (OR=1.34), ordering 0.3% more images per episode. 

Increased radiography orders were seen for APCs on both new and established patients (ORs=1.36 and 1.33, respectively), ordering 0.3% and 0.2% more images per episode of care, respectively. 

For advanced imaging, increased imaging was seen in association with APCs for established patients (OR=1.28), ordering 0.1% more images, while for new patients there was no significant difference between APCs and PCPs.

“While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level,” the researchers wrote.


  1. Hughes DR et al. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.6349.