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ADVANCE Voice: NP

Study: NPs Provide Better Diabetes Care

Published January 22, 2008 8:10 AM by Jill Rollet

That's right — better care than physicians and better care than physician assistants (PAs), according to a study just published in the Annals of Family Medicine (Ohman-Strickland PA, et al. Quality of Diabetes Care in Family Medicine Practices: Influence of Nurse-Practitioners and Physician's Assistants. Annals of Family Medicine 6:14-22 [2008]).

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.

Researchers had hoped to discover reasons for any differences in quality of care, but no clear explanations emerged from the data. They speculate that perhaps practices with NPs experience better communication, cross-training, shared decision making and mutual respect of diverse roles. Or perhaps the difference in outcomes had something to do with a nursing approach as opposed to a medical approach.

They also speculate that perhaps different types of patients tend to be assigned to different types of providers: "Complex patient cases may be assigned to physicians, more routine or acute cases may be assigned to PAs, and cases requiring a more preventive approach may be assigned to NPs. Theoretically, this could lead to more efficient and individualized patient care."

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