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Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse-Practitioners and Physician’s Assistants

¹ Department of Biostatistics, UMDNJ-School of Public Health, Piscataway, New Jersey
² Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey
³ The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey
⁴ HealthPartners Medical Group and HealthPartners Research Foundation, Minneapolis, Minnesota
⁵ Center for Research in Family Practice and Primary Care, Cleveland, Ohio
⁶ Department of Epidemiology, UMDNJ-School of Public Health, Piscataway, New Jersey

CORRESPONDING AUTHOR: Pamela A. Ohman-Strickland, PhD Department of Biostatistics UMDNJ-School of Public Health 683 Hoes Ln W, Room 218 PO Box 9 Piscataway, NJ 08854 ohmanpa{at}umdnj.edu

PURPOSE The aim of this study was to assess whether the quality of diabetes care differs among practices employing nurse-practitioners (NPs), physician’s assistants (PAs), or neither, and which practice attributes contribute to any differences in care.

METHODS This cross-sectional study of 46 family medicine practices from New Jersey and Pennsylvania measured adherence to American Diabetes Association diabetes guidelines via chart audits of 846 patients with diabetes. Practice characteristics were identified by staff surveys. Hierarchical models determined differences between practices with and without NPs or PAs.

RESULTS Compared with practices employing PAs, practices employing NPs were more likely to measure hemoglobin A_1c levels (66% vs 33%), lipid levels (80% vs 58%), and urinary microalbumin levels (32% vs 6%); to have treated for high lipid levels (77% vs 56%); and to have patients attain lipid targets (54% vs 37%) (P .005 for each). Practices with NPs were more likely than physician-only practices to assess hemoglobin A_1c levels (66% vs 49%) and lipid levels (80% vs 68%) (P.007 for each). These effects could not be attributed to use of diabetes registries, health risk assessments, nurses for counseling, or patient reminder systems. Practices with either PAs or NPs were perceived as busier (P=.03) and had larger total staff (P <.001) than physician-only practices.

CONCLUSIONS Family practices employing NPs performed better than those with physicians only and those employing PAs, especially with regard to diabetes process measures. The reasons for these differences are not clear.

Key Words: Family medicine • nurse practitioners • physician assistants • diabetes mellitus • quality of health care • practices • professional practice • office visits • long-term care • disease management • patient care management

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