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Summaries for Patients |18 December 2018

Comparing Diabetes Outcomes for Primary Care Provided by Physicians, Nurse Practitioners, and Physician Assistants Free

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Author, Article, and Disclosure Information
This article was published at Annals.org on 20 November 2018.

  • From: Jackson GL, Smith VA, Edelman D, Woolson SL, Hendrix CC, Everett CM, et al. Intermediate diabetes outcomes in patients managed by physicians, nurse practitioners, or physician assistants. A cohort study. Ann Intern Med. 2018;169:825-35. doi:10.7326/M17-1987


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    • Why did the researchers do this particular study?
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What is the problem and what is known about it so far?

The number of people in the United States who need primary care is growing faster than the increase in primary care physicians. Many experts predict that in the future, there will be too few primary care physicians to care for all the people who need them.

Why did the researchers do this particular study?

Nurse practitioners (NPs) and physician assistants (PAs) can provide some types of primary care, but not enough is known about which parts of primary care are appropriate for them.

Who was studied?

More than 368,000 patients with the most common form of adult diabetes (type 2 diabetes mellitus) who received care in the U.S. Department of Veterans Affairs (VA) health system from physicians, NPs, and PAs.

How was the study done?

Researchers used electronic health records to identify which type of clinician was responsible for each patient. They then examined intermediate outcomes that are easy to measure, make a difference in long-term health, and are affected by the quality of patient care. The researchers focused on blood pressure and on the results of tests for blood sugar (hemoglobin A1c) and blood lipids (low-density lipoprotein cholesterol, or LDL-C). The researchers adjusted the data to remove differences in each patient's outcomes that were related to the patient's severity of illness, which revealed any remaining difference related to the type of clinician.

What did the researchers find?

They did not find any clinically significant differences in patient outcomes that were related to the type of PCP who provided care.

What were the limitations of the study?

Patients within the VA health system are primarily men who receive care provided by teams with several types of clinicians, so it is difficult to know how to apply these results to other systems of care.

What are the implications of the study?

Physicians, NPs, and PAs can provide equally effective care for adults with the most common form of diabetes, and perhaps for patients with other chronic diseases, when these clinicians work in a health system that provides appropriate support.

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Comparing Diabetes Outcomes for Primary Care Provided by Physicians, Nurse Practitioners, and Physician Assistants. Ann Intern Med. 2018;169:I–16. [Epub ahead of print 20 November 2018]. doi: https://doi.org/10.7326/P18-0017

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Published: Ann Intern Med. 2018;169(12):I-16.

DOI: 10.7326/P18-0017

Published at www.annals.org on 20 November 2018

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2018 American College of Physicians
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