Nurse Practitioners and Physician Assistants Equivalent to Doctors in Chronic Illness Care

In NP, PA, and physician treatment of diabetes patients, no significant difference is found in three clinical measures.

Nurse practitioners and physician assistants are as well equipped to treat patients with chronic illnesses as physicians, recent research indicates.

The finding is a boost for advocates of deploying nurse practitioners (NPs) and physician assistants (PAs) to ease the country's physician shortage. The country is facing a projected shortfall as high as 104,000 physicians by 2030, according to a report by the Association of American Medical Colleges.  

Research published last month in Annals of Internal Medicine found no significant clinical variation in care for treatment of diabetes by nurse practitioners, physician assistants, and physicians.

"In our study, we did not identify any clinically meaningful differences in commonly measured intermediate diabetes outcomes among patients with NP, PA, or physician primary care providers," the lead author of the research, George Jackson, PhD, MHA, of Durham VA Medical Center in Durham, North Carolina, told HealthLeaders this week.

The study featured 368,000 adult patients. The clinical measures examined were continuous and dichotomous control of hemoglobin A1c, systolic blood pressure, and low-density lipoprotein cholesterol.

"No clinically significant variation was found among the three primary care provider types with regard to diabetes outcomes, suggesting that similar chronic illness outcomes may be achieved by physicians, NPs, and PAs," Jackson and his colleagues wrote.

Diabetes has key characteristics that are similar to many other chronic illnesses, Jackson said.

"Diabetes represents an important indicator of care quality because it involves both complex medication management and helping patients learn to how to manage the illness themselves; for example, taking medicine as prescribed, changing diet, or getting more exercise," he said.

In the primary care setting, it appears ill-advised to place limits on the conditions that NPs and PAs treat, Jackson said.

"I would not say there are specific conditions that per se should or should not be cared for by specific types of primary care providers. Like all clinicians, primary care providers consider specific patient circumstances when deciding which other clinicians should be included as part of the care team or consulted when addressing patient needs," he said.

An editorial accompanying the Jackson team's research calls for giving NPs and PAs a higher degree of respect.

"It is time to stop calling NPs and PAs 'midlevel' providers, as is common in certain systems. Nurse practitioners and PAs are competent primary care providers in their own right and should be fully accepted as such," the editorial says.