VA study backs use of physician assistants, nurse practitioners in diabetes care

June 07, 2019

Veterans Affairs patients with diabetes have similar health outcomes regardless of whether their primary provider is a physician, nurse practitioner (NP), or physician assistant (PA), according to a Durham VA Health Care System study.

The results appear in the June 2019 edition of the Journal of the American Academy of Physician Assistants.

"Our study found that there were not clinically important differences in intermediate diabetes outcomes for patients with physicians, NPs, or PAs in both the usual and supplemental provider roles, providing additional evidence for the role of NPs and PAs as primary care providers," said Dr. George Jackson, senior author on the paper.

Jackson is a research health scientist with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center in North Carolina. He is also an associate professor at Duke University.

Several years ago, VA instituted Patient Aligned Care Teams (PACTs) primary care model. PACTs involve a team of care providers working together with veterans to focus on wellness and disease prevention in addition to treatment.

Each PACT is led by either a physician, NP, or PA, and any one of those disciplines can also serve as a supplemental provider, supporting the main provider in the PACT. Within VA, about one-third of primary care visits are with PAs or NPs, rather than with physicians. While care teams led by PAs or NPs are becoming more and more common, questions remain about whether patients do as well with non-physicians leading their care.

The researchers turned to a large patient population within VA who often have complex health care needs those with diabetes. The researchers looked at the electronic health records of more than 600,000 veterans with diabetes.

A physician was the usual provider for 77% of these patients. The researchers did not find any statistically significant difference in quality of care based on the discipline of either the usual care provider or supplemental care providers. Patients whose usual care provider was a physician had similar health outcomes to those who mostly saw a PA or NP.

Whether supplemental primary care providers were physicians or other providers also did not result in clinically important differences in patient outcomes.

For example, compared to physician-only care, patients who saw only PAs in primary care had a 0.03% decrease in HbA1c (a measure of blood sugar, with lower numbers meaning better diabetes control). Patients who saw NPs only in primary care had a 0.06% decrease in HbA1c compared to those who saw physicians only. The differences were not large enough to be considered significant, meaning the results across those groups of patients were about equal.

While the researchers acknowledge that some patients may still prefer that their care be overseen by a physician, other studies have shown that patients are generally satisfied with care from NPs or PAs. VA has been guided in part by such past findings in expanding the use of PAs and NPs as team leaders.

The fact that PAs and NPs had similar results for quality of care without sharing care with a physician suggests that using these providers in primary care may improve the efficiency of health care, say the researchers.
-end-


Veterans Affairs Research Communications

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.