Treatment decisions for complex patients: differences between primary care physicians and midlevel providers

Area of Science:

• Cardiology
• Endocrinology
• Primary Care Medicine

Background:

• Elevated blood pressure (BP) is a common comorbidity in patients with diabetes mellitus.
• The roles of physicians and midlevel providers (nurse practitioners [NPs] and physician assistants [PAs]) in managing chronic conditions are expanding.
• Understanding differences in treatment approaches by provider type is crucial for optimizing patient care.

Purpose of the Study:

• To investigate if treatment changes for elevated BP in diabetic patients differ between physicians and midlevel providers.
• To identify potential reasons for any observed disparities in treatment adjustments.

Main Methods:

• Prospective cohort study involving 1169 diabetic patients across 9 Veterans Health Administration facilities.
• Analysis of treatment changes for elevated BP (>=140/90 mm Hg) based on provider type (physicians, NPs, PAs).
• Statistical modeling to control for patient characteristics and visit-specific factors.

Main Results:

• Physicians initiated treatment changes for elevated BP more frequently than midlevel providers (53.8% vs 36.4%, P = .001).
• This difference persisted even after controlling for patient factors and visit-specific variables (52.5% vs 37.5%, P = .02).
• No significant differences were found in patient demographics or baseline BP between groups.

Conclusions:

• Midlevel providers were less likely to adjust BP treatment in diabetic patients with elevated BP compared to physicians.
• The study did not identify clear explanations for this difference in treatment modification.
• Further investigation is warranted to determine if these disparities in treatment changes impact long-term BP control in complex diabetic patients.