The Veterans Health Administration (VHA) has experienced problems with recruiting and retention of primary care physicians, similar to other health care systems. As a result, it has moved to use nurse practitioners and physician assistants in acute and chronic-care roles, when possible. It should come as no surprise to retail health care practitioners that one of those roles is care for patients who have diabetes.
TheAmerican Journal of Medicinehas published an article that looks at the quality of care provided by nurse practitioners and physician assistants and compares such care to that provided by physicians.
This study looked at 19,238 newly diagnosed patients enrolled in VHA care and followed them with 4 years of follow-up. Patients seen by nurse practitioners, physician assistants, and physicians had similar HbA1c levels at diagnosis, similar complexities, and similar demographic features.
The authors looked at HbA1c trends among the patient population and found that in general, VHA patients had HbA1c levels of between 6.5% and 7% after 4 years. For this reason, they suggested that the processes and algorithms used within the VHA may explain some of the success. However, it does not completely explain the difference because in some geographic locations, the VHA does not follow a specific algorithm for diabetes.
The study found that regardless of who treated these patients, the outcomes were very similar. All 3 provider types tended to initiate first and second oral medications at about the same time. Nurse practitioners tended to encourage patients to start insulin at HbA1c levels that were slightly lower than patients seen by the other 2 providers. However, the difference was not clinically significant.
Patients seen by physician assistants were less likely to use insulin compared to patients seen by physicians, and the authors indicated that this could be because they were managed better or had less complex diabetes.
The study did not look at medication adverse effects or management of cardiovascular risk factors. It also did not look at episodes of hypoglycemia.
The authors conclude that nurse practitioners and physician assistants perform as well as physicians do in the first 5 years after a diagnosis of diabetes. This confirms that these health care professionals can help alleviate the primary care physician shortage.
Yang Y, Long Q, Jackson SL, Rhee MK, Tomolo AL, Olson DL, et al. Nurse practitioners, physician assistants, and physicians are comparable in managing the first five years of diabetes.Am J Med.2017;pii:S0002-9343(17)30904-X. doi: 10.1016/j.amjmed.2017.08.026.