November 8, 2015
Have Type 2 Diabetes, See a Nurse Practitioner
If you live in a state that allows nurse practitioners to practice unsupervised or even in a state that allows them to be supervised, and you have type 2 diabetes, you may be better treated by seeing a nurse practitioner.
“Nurse practitioners' patients had a 10% lower risk of hospitalization for a potentially preventable condition (odds ratio [OR], 0.90) and a 6% lower risk of hospitalization for poor diabetes control, such as hypoglycemia or hyperglycemia (OR, 0.94), compared with patients of physicians. Similarly, the odds for hospitalization for other conditions were slightly lower among nurse practitioners' patients than among physicians' patients (OR, 0.96).”
“The researchers compared potentially preventable hospitalizations from 2007 to 2010 among 345,819 Medicare patients with any diagnosis of diabetes. Of these, 93,443 patients had received all their primary care from nurse practitioners (a total of 136,348 person-years), and 252,376 patients had received all their care from a generalist physician (553,890 person-years).”
The all-cause mortality between the two groups was statistically the same in the four years of the study.
Coauthor Mukaila A. Raji, MD, told Medscape Medical News, "We find it surprising that the findings of lower rate of potentially avoidable hospitalization among nurse practitioners patients still hold true, despite use of multiple advanced analyses to adjust for complexity and severity of illnesses between diabetes patients cared for by nurse practitioners vs MDs."
The researchers explain that primary care provided by nurse practitioners has been promoted as necessary to lessen the shortage of primary-care physicians.
A 15-fold increase in the number of patients receiving care from nurse practitioners from 1998 to 2010, and 22 US states have changed their policies to allow nurse practitioners to practice and prescribe without physician supervision.
Some medical groups have raised concerns about primary care delivered solely by nurse practitioners, arguing that outcomes might not be comparable, particularly in complex patients. A number of trials in controlled settings have found comparable outcomes between the two groups, but there have been no population-based studies of outcomes of primary care delivered by nurse practitioners and MDs.
“The current results show that patients of nurse practitioners were more likely to live in rural areas and be younger, female, and white and have lower income, possibly because individuals with these demographics may be more open to receiving care from nurse practitioners, Dr Raji suggested.” “And yet the findings reveal that nurse practitioners provide the same quality of clinical care as MDs, he added.”
"Reducing unnecessary hospital admissions and readmissions is a key benchmark of quality and the basis for financial reimbursement for the healthcare system."
"Our finding of the association of nurse practitioners' diabetes primary care with lower risk of avoidable hospitalizations likely reflects the unique skills of nurse practitioners in care coordination, transitional care management, advance care planning, and preventive care," he concluded.
The research was funded by the Agency for Healthcare Research and Quality and the National Institutes of Health. The authors reported no relevant financial relationships.