Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Kuo, Yong‐Fang; Goodwin, James S.; Chen, Nai‐Wei; Lwin, Kyaw K.; Baillargeon, Jacques; Raji, Mukaila A.
• Is Part Of: Journal of the American Geriatrics Society. Volume 63:Issue 10(2015:Oct.)
• Page Start: 1980
• Page End: 1988
• Publication Date: 2015-10
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.13662
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs13662-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs13662-sec-0001" sec-type="section"> <title>Objectives</title> <p>To compare processes and cost of care of older adults with diabetes mellitus cared for by nurse practitioners (NPs) with processes and cost of those cared for by primary care physicians (PCPs).</p> </sec> <sec id="jgs13662-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective cohort study.</p> </sec> <sec id="jgs13662-sec-0003" sec-type="section"> <title>Setting</title> <p>Primary care in communities.</p> </sec> <sec id="jgs13662-sec-0004" sec-type="section"> <title>Participants</title> <p>Individuals with a diagnosis of diabetes mellitus in 2009 who received all their primary care from NPs or PCPs were selected from a national sample of Medicare beneficiaries (N = 64, 354).</p> </sec> <sec id="jgs13662-sec-0005" sec-type="section"> <title>Measurements</title> <p>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 (PIMs).</p> </sec> <sec id="jgs13662-sec-0006" sec-type="section"> <title>Results</title> <p>Nurse practitioners and PCPs 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 NPs 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). NPs 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 PIMs (OR = 1.07, 95% CI = 1.01–1.12). There was no statistically significant difference in adjusted Medicare spending between the two groups (<italic>P</italic> = .56).</p> </sec> <sec id="jgs13662-sec-0007" sec-type="section"> <title>Conclusion</title> <p>Nurse practitioners were similar to PCPs or slightly lower in their rates of diabetes mellitus guideline–concordant care. NPs used specialist consultations more often but had similar overall costs of care to PCPs.</p> </sec> </abstract>