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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. In this study, no significant differences were seen in the diabetes outcomes of patients managed by nurse practitioners (NPs) or physician assistants (PAs) compared to patients managed by physician primary care providers (PCPs).

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2. The results of the study indicated that chronic illnesses could be effectively managed by any of the three forms of PCPs.

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Evidence Rating Level: 2 (Good)

Study Rundown:

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In addition to primary care physicians, NPs and PAs are trained to be able to manage chronic conditions, such as diabetes. The authors of this study aimed to examine all three PCPs to assess whether NPs and PAs could be a possible solution to workforce shortages. The authors specifically assessed intermediate diabetes outcomes among patients of these three PCPs. The study concluded that there were no significant differences in diabetes outcomes regardless of which PCP was responsible for care. As a result, the authors suggest that NPs and PAs could help fill gaps in primary care for managing chronic conditions. The limitations of this study included that the majority of patients in this study were male and may not be represent a more generalized population.

In-Depth [cohort study]:

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The authors conducted a cohort study that utilized data from the U.S. Department of Veterans Affairs electronic health record. The study outcomes included hemoglobin A1c (HbA1c), systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) of patients with diabetes. A total of 368 481 patients with diabetes were included. The authors utilized hierarchical linear mixed and logistic regression models for data analysis. Generally, none of the differences were statistically significant between the three PCPs. For example, model-estimated differences in HbA1c compared to primary care physicians were -0.05% (95% CI, -0.07% to -0.02%) for NPs and 0.01% (CIs, -0.02% to 0.04%) for PAs. Furthermore, differences for SBP were 0.08mmHg (CI, -0.34 to 0.18 mmHg) for NPs and 0.02 mmHg (CI, -0.42 to 0.38 mmHg) for PAs.

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