Effectiveness of care and healthcare resource use among nurse practitioners (NPs) and physician assistants (PAs) are comparable when treating patients with diabetes or cardiovascular disease (CVD), according to a study published in the Journal of the American Academy of Physician Assistants.

A team of investigators from the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston, Texas, used data sources from the Veterans Health Administration to identify patients with diabetes or CVD in 130 various facilities. Patients included in the study visited their primary care clinician between October 1, 2013, and September 30, 2014. After applying exclusion criteria, the diabetes cohort included 210,624 patients, and the CVD cohort included 251,911 patients.

The researchers compared age, sex, race, history of hypertension, primary care treatment at a teaching facility, and provider panel size, as well as the effectiveness of care given by NPs or PAs to patients with diabetes or CVD. Effectiveness outcomes for patients with diabetes included glycemic control (HbA1c <9%), blood pressure control (<140/90 mm Hg), and statin therapy. For the CVD cohort, the researchers compared the same measures of blood pressure control, beta-blocker therapy among those with a history of myocardial infarction in the last 2 years, antiplatelet therapy, and statin therapy.

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Resource use for the diabetes cohort was determined by calculating the number of primary and specialty care visits and the number of lipid panels and HbA1c tests per patient in the past year or within 2 weeks following their last primary care visit.  Resource use for the CVD cohort was measured using the same parameters, in addition to the number of stress tests per patient.

A total of 156,034 patients with diabetes received care from 1325 NPs and 54,590 received care from 409 PAs, and 185,694 patients with CVD received care from 1370 NPs and 66,217 patients received care from 413 PAs. Approximately 90% of NPs were women compared with 51% of PAs, and NPs were older than PAs (55 years vs 53 years). Glycemic control, blood pressure control, and statin therapy were found to be comparable among patients cared for by both types of providers. For patients with a myocardial infarction within the previous 2 years, blood pressure control and therapy with a statin, antiplatelet agent, or beta-blocker were also comparable among those receiving treatment from an NP vs a PA.

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“Patients cared for by NPs and PAs had a similar number of primary and [specialty] care visits, and number of lipid panels and [HbA1c] tests ordered in the past year or within 2 weeks following their last primary care visit,” the researchers found. “Patients with CVD cared for by both types of providers had a similar number of primary and [specialty] care visits, lipid panels, and stress tests.”

The results of the study indicate that diabetes and CVD are managed equally effectively by NPs and PAs.


Faza NN, Akeroyd JM, Ramsey DJ, et al. Effectiveness of NPs and PAs in managing diabetes and cardiovascular disease. JAAPA. 2018;31(7):39-45.