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Adherence to Standards of Practice Treating Diabetes between Physicians and Nurse Practitioners: The National Hospital and Ambulatory Medical Care Surveys

Background: Much of the evidence of adherence to mutually agreed-upon rules for the treatment of diabetes among physicians and nurse practitioners comes from single clinics or registries, which leaves open the question as to whether these findings are nationally representative of current practice.

Aim: To evaluate standards of practice for treatment of diabetes among physicians and nurse practitioners across the United States.

Design: Observational study design using large, publicly available datasets.

Methods: We used data from the 2009-2011 National Hospital and Ambulatory Medical Care Surveys NAMCS, NHAMCS). We assessed standards of practice (HbA1c, foot exams, retinal exams) and delivery of patient education, using the checkbox for diabetes to identify all patients. We then examined differences in treatment using multivariate logistic regression models.

Results/findings: A total sample of 10,551 ambulatory and 11,546 outpatient department (OPD) records were analyzed (unweighted counts). Patient characteristics associated with provider adherence in both settings were identified by pairwise analysis. After adjustment and assigning survey weights, care was similar between both providers in ambulatory settings. Odds of receiving HbA1c were 2.47 times higher among nurse practitioners in OPD after adjustment. Across both surveys, nurse practitioners had lower odds of providing certain forms of patient education and counseling, including diet/nutrition, health education and ‘other’ education (p<0.05).

Conclusion: Using nationally representative databases for ambulatory and OPD visits, we found that physicians were more likely to deliver patient-based education and counseling, but were similar compared to nurse practitioners or slightly lower in the odds of delivering mutually agreed-upon treatment of diabetes.


Amanda Myhren-Bennett, Nathaniel Bell

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