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Employment of mid-level providers in primary care and control of diabetes
Primary Care Diabetes, 03/30/2011
Jackson GL et al. - Diabetes control among primary care patients appeared to benefit from inclusion of nurse practitioners (NPs), while an analogous association was not found for physician assistants (PAs).
Methods- A cohort of diabetes patients (alive October 1, 1999) using the Veterans Affairs (VA) Diabetes Registry and VA corporate databases was established.
- 1999 VA Survey of Primary Care Practices data were combined with individual-patient information.
- Two-level hierarchical model to determine the relationship between staffing characteristics and hemoglobin A1c (HbA1c) was used.
- 88,682 patients from 198 clinics were enrolled.
- NPs at relatively limited levels (% of all providers who are NPs) in the primary care program was significantly associated with HbA1c lower by 0.31 percentage points (95% CI, -0.50% to -0.12%) compared to programs that did not include NPs.
- Having some level of NP staffing vs. no NP staffing was associated HbA1c lower by 0.25%.
- Inclusion of PAs in primary care programs was generally not associated with a statistically significant difference in HbA1c.
- The exception is that moderate levels of PA staffing were associated with slightly higher HbA1c [0.18%, 95% CI, 0.02-0.34)].
