Patients With Diabetes May Not End Up In The Hospital When Nurse Practitioners Administer Primary Care

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New research shows diabetic patients who receive primary care from a nurse practitioner do not see an increase in potentially preventable hospital admissions. Defence Images (CC BY-SA 2.0)

Receiving primary care from a nurse practitioner versus a doctor may not increase risk for preventable hospital admissions after all, finds a new study.

"Our data analysis revealed that older diabetic patients who received all of their primary care from nurse practitioners had lower rates of potentially preventable hospitalization than those who received primary care from physicians in nonmetropolitan urban and rural areas," said lead study author Yong-Fang Kuo, a professor of preventative medicine and community health at the University of Texas Medical Branch in Galveston, in a press release. "There were no differences between patients cared for by nurse practitioners versus physicians in urban areas."

Kuo and her team examined health care information from a national sample of 345,819 diabetic patients receiving Medicare. Researchers chose to focus on diabetic patients because it is a manageable, chronic condition for which good primary care would reduce hospitalizations. Kuo explained that a focus on rural areas was also important because there has been a shortage of physicians in rural areas for the last 30 years, making primary care by nurse practitioners of particular interest.

There is a shortage of primary care physicians in the current health care landscape, making it difficult for those with chronic conditions to receive regular primary care. Using nurse practitioners is one way to address the shortage, and people are taking advantage of the option. There was a 15-fold increase in the number of Medicare patients receiving primary care from a nurse practitioner from 1998 to 2010, but some medical groups have argued that primary care delivered by a nurse practitioner may cause differing health outcomes for their patients than for those seeing physicians.

Yet physicians, if even available, have a large patient load, which limits their ability to spend quality time with patients or follow-up appropriately. Past studies have demonstrated that nurse practitioners tend to spend more time with their patients and follow-up more frequently than physicians do.

"These findings support previous research suggesting that nurse practitioners provide the same quality of clinical care as physicians," said Kuo. "In view of the growing role of nurse practitioner in the U.S. health care system, information in the quality of nurse practitioner care holds broad clinical and public health relevance."

Source: Kuo Y, Chen N, Bailargeon J, Raji M, Goodwin J. Potentially Preventable Hospitalizations in Medicare Patients With Diabetes: A Comparison of Primary Care Provided by Nurse Practitioners Versus Physicians. Medical Care. 2015.

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