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Study Shows No Difference in Intermediate Outcomes for Veterans with Diabetes by Type of Primary Care Provider


BACKGROUND:
Almost half of U.S. patients with diabetes see a nurse practitioner (NP) or a physician assistant (PA) for some part of their care. In addition, about one-third of primary care visits in the VA healthcare system and community health centers are with NPs or PAs. However, few studies have compared chronic illness outcomes of primary care provided by PAs versus NPs separately or physicians. Therefore, this study examined whether intermediate diabetes outcomes differed among 368,481 Veterans treated at one of 568 VA primary care facilities by a physician (n=3,487), NP (n=1,445), or PA (n=443) primary care provider. The provider most often visited at the respective Veteran's VA primary care clinic in FY2012 was considered his or her primary care provider. Investigators examined the association between provider type and control of hemoglobin A1c (HbA1c), systolic blood pressure, and low-density lipoprotein cholesterol (LDL-C) based on mean values in FY2013. Covariates included demographics, social complexity measures, health status, access to services, and facility practice patterns.

FINDINGS:

  • There were no clinically significant differences in intermediate diabetes outcomes – or the control of those outcomes – among patients with NP, PA, or physician primary care providers.
  • There also was no clinically significant difference in the proportions of NP, PA, and physician-treated patients with diabetes who used endocrinology or specialty diabetes services – 8.5%, 9.8%, and 9.2%, respectively – during the year outcomes were calculated.

IMPLICATIONS:

  • This study provides further evidence that using NPs and PAs as primary care providers may represent a mechanism for expanding access to primary care while maintaining quality standards.

LIMITATIONS:

  • This study based patient and provider characteristics on one year (FY12) and looked at outcomes for the next year (FY13); it did not examine long-term information regarding disease trajectory.
  • Investigators did not have access to information on the demographic or work history characteristics of providers included in this study.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 13-063). A former HSR&D Career Development Awardee, Dr. Jackson is Director of the Implementation/Improvement Lab at HSR&D's Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC. Drs. Smith, Edelman, and Hendrix; Mss. Woolson and White; and Mr. Berkowitz also are part of ADAPT.


PubMed Logo Jackson G, Smith V, Edelman D, Woolson S, Hendrix C, Everett C, Berkowitz T, White B, Morgan P. Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants. Annals of Internal Medicine. December 18, 2018;169(12):825-35.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.