Journal
ANNALS OF FAMILY MEDICINE
Volume 6, Issue 1, Pages 14-22Publisher
ANNALS FAMILY MEDICINE
DOI: 10.1370/afm.758
Keywords
-
Categories
Funding
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [R01HL070800] Funding Source: NIH RePORTER
- NHLBI NIH HHS [R01 HL70800] Funding Source: Medline
Ask authors/readers for more resources
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.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available