Primary care provider type: Are there differences in patients' intermediate diabetes outcomes?

JAAPA

Christine M. Everett is an associate professor in the PA program in the Department of Family Medicine and Community Health and the Department of Population Health Sciences at Duke University School of Medicine in Durham, N.C. Perri Morgan is director of research and a professor in the PA program in the Department of Family Medicine and Community Health and the Department of Population Health Sciences at Duke University School of Medicine. Valerie A. Smith is deputy director of the biostatistics unit at the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham (N.C.) Veterans Affairs Health Care System and an assistant professor in the Department of Population Health Sciences and General Internal Medicine at Duke University School of Medicine. Sandra Woolson is a statistician at ADAPT. David Edelman is a research associate at ADAPT and a professor in the Department of General Internal Medicine at Duke University School of Medicine. Cristina C. Hendrix is a nurse investigator and practices in the geriatric outpatient clinic at ADAPT and an associate professor of nursing at Duke University School of Nursing. Theodore Berkowitz is a statistician and Brandolyn White is a research health sciences specialist at ADAPT. George L. Jackson is a research health scientist at ADAPT and an associate professor in the Department of Population Health Sciences and Divison of General Internal Medicine at Duke University School of Medicine. This research was supported by a grant from Department of Veterans Affairs (VA) Health Services Research and Development Service IIR 13-063 and the Center of Innovation for Health Services Research in Primary Care (CIN 13-410) at the Durham VA. The grant funding source had no role in the design, conduct, collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. The views expressed in this article are those of the authors and do not reflect the position or policy of the Department of Veterans Affairs or the US government. The authors have disclosed no potential conflicts of interest, financial or otherwise.

Published: June 2019

Growing demand for services is leading primary care organizations to explore new delivery models. One approach incorporates multiple primary care providers on a team. Effective incorporation of multiple clinicians into teams requires well-defined roles, including the usual provider (who provides the majority of primary care) and supplemental providers (who provide a minority of primary care visits). Using data from the Veterans Health Administration, we examined whether differences in diabetes outcomes exist among patients with different types of primary and supplemental providers (physicians, physician assistants (PAs), and NPs). No clinically meaningful differences were observed based on the profession of the usual provider or supplemental provider, or whether physicians provided supplemental care to patients with PAs or NPs as usual providers. These results suggest that physicians, PAs, and NPs can perform a variety of roles depending on the needs of the organization and patient population.

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http://dx.doi.org/10.1097/01.JAA.0000558239.06875.0bDOI Listing

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