Family medicine practices with nurse-practitioners (NPs) perform better at providing some types of diabetes care (primarily monitoring tests) than physician-only practices and especially better than practices using physician assistants (PAs).
This cross-sectional study of 45 family medicine practices measured adherence to American Diabetes Association guidelines via chart audits of 846 diabetic patients and found that compared with practices employing PAs, practices employing NPs were more likely to measure hemoglobin A1c levels (66 percent vs. 33 percent), lipid levels (80 percent vs. 58 percent), and urinary microalbumin levels (32 percent vs. 6 percent); to have treated for high lipid levels (77 percent vs. 56 percent); and to have patients attain lipid targets (54 percent vs. 37 percent).
Practices with NPs were more likely than physician-only practices to assess hemoglobin A1c levels (66 percent vs. 49 percent) and lipid levels (80 percent vs. 68 percent).
The authors note it is not possible to conclude that the nurse-practitioner is the cause of the observed differences, but in light of the burgeoning use of PAs and NPs in attempts to cut costs and implement new models of clinical care, they assert these results point to a need to further explore these associations and their causes.
Journal reference: Pamela A. Ohman-Strickland, Ph.D., et al. Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse-Practitioners and Physician's Assistants. January/February 2008 Annals Of Family Medicine.
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