Patients using nurse practitioners are less likely to have avoidable hospital admissions

"Our data analysis revealed that older diabetic patients who received all of their primary care from nurse practitioners had lower rates of potentially preventable hospitalization than those who received primary care from physicians in nonmetropolitan urban and rural areas," said Yong-Fang Kuo, lead author and UTMB professor in the department of preventive medicine and community health. "There were no differences between patients cared for by nurse practitioners versus physicians in urban areas."

The study recently was published in the journal Medical Care.

Given the changing health care landscape, the medical community is encouraging people with chronic conditions like diabetes to receive regular primary care to avoid unnecessary hospital admissions. Unfortunately, there is a shortage of primary care physicians.

Primary care provided by nurse practitioners is one way to address this shortage. Increasingly more people are using nurse practitioners for their regular primary care visits. In fact, there was a 15-fold increase in the number of Medicare patients receiving care from nurse practitioners from 1998-2010. However some medical groups have raised concerns about primary care delivered solely by nurse practitioners, arguing that health outcomes for their patients might differ from those who use physicians.

The new study investigated billing information from 345,819 older diabetic patients using a national sample of Medicare beneficiaries using a broad range of analyses and study designs. The analysis focused on diabetic patients because it is a manageable condition for which good primary care should reduce hospitalizations.

Kuo said that discovering the impact of nurse practitioner care was stronger in nonmetropolitan areas is important, given that there has been a shortage of physicians in rural areas for the past 30 years. Physicians in rural areas may have a larger patient load, limiting their ability to spend sufficient time with each patient, or follow-up with them in a timely manner.

Prior studies have shown that nurse practitioners spend more time with their patients, give patients more information and follow-up more frequently than physicians do.

"These findings support previous research suggesting that nurse practitioners provide the same quality of clinical care as physicians. In view of the growing role of nurse practitioners in the US health care system, information on the quality of nurse practitioner care holds broad clinical and public health relevance," said Kuo.