Diabetes outcomes similar when primary care provided by NPs, PAs, or physicians, study finds
More care by nurse practitioners (NPs) and physician assistants (PAs) may be a way to expand primary care access while maintaining quality standards.
There were no significant differences in common diabetes outcomes between patients cared for by a primary care physician versus those cared for by a nurse practitioner (NP) or physician assistant (PA), a Veterans Affairs (VA) study found.
Researchers from the Durham VA Medical Center in North Carolina used electronic health record data, which included 568 VA primary care facilities and 368,481 adult patients with diabetes, to compare HbA1c levels, systolic blood pressure, and low-density lipoprotein (LDL) cholesterol levels in patients cared for the three different types of clinicians.
The findings were published Nov. 20 by Annals of Internal Medicine.
Most of the studied patients were cared for by physicians (n=3,487; 74.9% of patients), followed by NPs (n=1,445; 18.2%) and PAs (n=443; 6.9%). The difference in patients' HbA1c values compared with physician care was −0.05% (95% CI, −0.07% to −0.02%) for NPs and 0.01% (95% CI, −0.02% to 0.04%) for PAs. For systolic blood pressure, the difference was −0.08 mm Hg (95% CI, −0.34 to 0.18 mm Hg) for NPs and 0.02 mm Hg (95% CI, −0.42 to 0.38 mm Hg) for PAs. For LDL cholesterol, the difference was 0.01 mmol/L (95% CI, 0.00 to 0.03 mmol/L) (0.57 mg/dL [95% CI, 0.03 to 1.11 mg/dL]) for NPs and 0.03 mmol/L (95% CI, 0.01 to 0.05 mmol/L) (1.08 mg/dL [95% CI, 0.25 to 1.91 mg/dL]) for PAs. None of these differences were clinically significant.
According to the researchers, this study provides further evidence that care by NPs and PAs may represent a mechanism for expanding access to primary care while maintaining quality standards.
An accompanying editorial stated that the time has come to embrace different approaches to providing primary care, using different types of clinicians as well as delivery models such as telehealth.
“Moreover, it is time to stop calling NPs and PAs ‘midlevel’ providers, as is common in certain systems,” the editorial stated. “Nurse practitioners and PAs are competent [primary care providers] in their own right and should be fully accepted as such.”