Abstract
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 A1c 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 A1c 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.
- 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
Footnotes
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Conflicts of interest: none reported
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Funding support: Data collection and analysis were supported by a grant from the National Heart, Lung, and Blood Institute (R01 HL70800) and an AAFP Research Center Grant. This research was also supported by the Cancer Institute of New Jersey’s Primary Care Research shared resource.
An early version of this work was presented as a poster at the 2006 NAPCRG annual meeting, October 15-18, Tucson, Arizona.
- Received for publication March 13, 2007.
- Revision received July 25, 2007.
- Accepted for publication August 10, 2007.
- © 2008 Annals of Family Medicine, Inc.
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