Relationship between provider type and the attainment of treatment goals in primary care

To determine the relationship between provider type (eg, resident, mid-level practitioner, attending physician) and attainment of clinical goals with respect to the treatment of dyslipidemia, diabetes mellitus, and hypertension.

Using electronic medical records, we identified all patients seen in the Veterans Affairs Connecticut Health Care System in a 6-month period with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code corresponding to a diagnosis of coronary artery disease, diabetes mellitus, or hypertension.

We recorded the most recent low-density lipoprotein cholesterol level for patients with diabetes or coronary artery disease, glycosylated hemoglobin level for patients with diabetes, and blood pressure for patients with hypertension. We then examined the relationship between these measures and provider type.

After controlling for patient age and practice site, no significant differences were noted between attending physicians and residents in attaining treatment goals for dyslipidemia (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.96-1.38) or diabetes (OR 1.05, 95% CI 0.82-1.33). However, attending physicians were significantly more likely to attain blood pressure goals than were residents (59% vs 54%, P = .002; OR 1.23, 95% CI 1.08-1.39). Controlling for additional patient characteristics did not alter the findings.

Internal medicine residents may quickly develop expertise in managing dyslipidemia and diabetes mellitus. Residents in our sample, however, were less likely than attending physicians to reach goal blood pressure for patients with hypertension. Educational efforts aimed at house staff to improve the treatment of hypertension are warranted.