Diabetes care processes and outcomes in patients treated by nurse practitioners or physicians.
The purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners (NPs) and physicians (MDs) in the primary care of adults with type 2 diabetes.



Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and randomized to an NP or MD practice. Chart reviews were conducted to assess processes of care; patient interviews and hemoglobin A1C (A1C) testing were performed to measure patient outcomes.



NPs were more likely than MDs to document provision of general diabetes education and education about nutrition, weight, exercise, and medications. They were more likely to document patient height, urinalyses results, and A1C values. No differences were found in documenting current medications; alcohol, illicit drug, or tobacco use; depression; weight and blood pressure; foot and cardiovascular exams; blood glucose and creatinine testing; or referral to ophthalmologists. No differences were found in patient outcomes.



This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes. NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs; however, these differences were not reflected in 6-month patient outcomes.
Lenz
Elizabeth R
ER
Ohio State College of Nursing, Columbus, USA.
Mundinger
Mary O'Neil
MO
Columbia University School of Nursing, New York
Hopkins
Sarah C
SC
Columbia University School of Nursing, New York
Lin
Susan X
SX
Columbia University School of Nursing, New York
Smolowitz
Janice L
JL
Columbia University School of Nursing, New York
D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008485:Medical Audit; D008487:Medical History Taking / Q000592:standards; D008875:Middle Aged; D009518:New York; D009722:Nurse Practitioners / Q000592:standards*; D009730:Nursing Assessment / Q000592:standards; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000592:standards; D010821:Physicians, Family / Q000592:standards*; D011320:Primary Health Care / Q000592:standards
D006442:Glycated Hemoglobin