Diabetes mellitus care provided by nurse practitioners vs primary care physicians

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Abstract

Objectives 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). Design Retrospective cohort study. Setting Primary care in communities. Participants 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). Measurements 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). Results 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 (P =.56). Conclusion 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.

Original languageEnglish (US)
Pages (from-to)1980-1988
Number of pages9
JournalJournal of the American Geriatrics Society
Volume63
Issue number10
DOIs
StatePublished - Oct 1 2015

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Nurse Practitioners
Primary Care Physicians
Diabetes Mellitus
Odds Ratio
Confidence Intervals
Medicare
Costs and Cost Analysis
LDL Cholesterol
Primary Health Care
Referral and Consultation
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Propensity Score
Medication Adherence
Angiotensin Receptor Antagonists
Glycosylated Hemoglobin A
Angiotensin-Converting Enzyme Inhibitors
Cohort Studies
Retrospective Studies
Guidelines
Hypertension

Keywords

  • diabetes mellitus
  • Medicare
  • nurse practitioner
  • primary care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Diabetes mellitus care provided by nurse practitioners vs primary care physicians. / Kuo, Yong Fang; Goodwin, James; Chen, Nai Wei; Lwin, Kyaw K.; Baillargeon, Jacques; Raji, Mukaila.

In: Journal of the American Geriatrics Society, Vol. 63, No. 10, 01.10.2015, p. 1980-1988.

Research output: Contribution to journalArticle

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abstract = "Objectives 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). Design Retrospective cohort study. Setting Primary care in communities. Participants 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). Measurements 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). Results 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 (P =.56). Conclusion 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.",
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AU - Raji, Mukaila

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N2 - Objectives 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). Design Retrospective cohort study. Setting Primary care in communities. Participants 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). Measurements 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). Results 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 (P =.56). Conclusion 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.

AB - Objectives 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). Design Retrospective cohort study. Setting Primary care in communities. Participants 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). Measurements 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). Results 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 (P =.56). Conclusion 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.

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