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.
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