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Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians
Author(s) -
Kuo YongFang,
Goodwin James S.,
Chen NaiWei,
Lwin Kyaw K.,
Baillargeon Jacques,
Raji Mukaila A.
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13662
Subject(s) - medicine , diabetes mellitus , odds ratio , confidence interval , propensity score matching , retrospective cohort study , nephropathy , emergency medicine , primary care physician , primary care , family medicine , endocrinology
Objectives To compare processes and cost of care of older adults with diabetes mellitus cared for by nurse practitioners ( NP s) with processes and cost of those cared for by primary care physicians ( PCP s). Design Retrospective cohort study. Setting Primary care in communities. Participants Individuals with a diagnosis of diabetes mellitus in 2009 who received all their primary care from NP s or PCP s were selected from a national sample of Medicare beneficiaries (N = 64,354). Measurements Propensity score matching within each state was used to compare these two cohorts with regard to rate of eye examinations, low‐density lipoprotein cholesterol ( LDL ‐C) and glycosylated hemoglobin (HbA1C) testing, nephropathy monitoring, specialist consultation, and Medicare costs. The two groups were also compared regarding medication adherence and use of statins, angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers (for individuals with a diagnosis of hypertension), and potentially inappropriate medications ( PIM s). Results Nurse practitioners and PCP s had similar rates of LDL ‐C testing (odds ratio (OR) = 1.01, 95% confidence interval (CI) = 0.94–1.09) and nephropathy monitoring (OR = 1.05, 95% CI = 0.98–1.03), but NP s had lower rates of eye examinations (OR = 0.89, 95% CI = 0.84–0.93) and HbA1C testing (OR = 0.88, 95% CI = 0.79–0.98). NP s were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21–1.37), endocrinologists (OR = 1.64, 95% CI = 1.48–1.82), and nephrologists (OR = 1.90, 95% CI = 1.67–2.17) and more likely to have prescribed PIM s (OR = 1.07, 95% CI = 1.01–1.12). There was no statistically significant difference in adjusted Medicare spending between the two groups ( P = .56). Conclusion Nurse practitioners were similar to PCP s or slightly lower in their rates of diabetes mellitus guideline–concordant care. NP s used specialist consultations more often but had similar overall costs of care to PCP s.