Patient Perception of Midlevel Providers in Pediatric Diabetes Care

The purpose of this study was to evaluate perceptions of the role of midlevel providers among pediatric type 1 diabetes patients.

The study population was a convenience sample of 82 youth with type 1 diabetes who were enrolled in the SEARCH for Diabetes in Youth Study, Carolina site, and attended either baseline (n = 22) or follow-up (n = 60) visits between May 25, 2012, and October 3, 2012. Self-administered surveys queried participants' understanding of providers' roles and perceived employment at clinics and whether participants had seen providers since diagnosis. Midlevel providers of interest included dietitians, nurse practitioners, physician assistants, and medical social workers. Mean proportions for each provider were compared to dietitians (referent) via a t test. Fisher exact tests were used to determine associations between survey responses.

Baseline participants reported seeing a dietitian since diagnosis more often than they reported seeing an nurse practitioner, physician assistant, or medical social worker. Baseline and follow-up participants both reported understanding the role of dietitians significantly more than the role of other providers. Dietitians were reported by all participants to be employed at clinics more frequently than physician assistants or medical social workers. Seeing the provider was associated with patients' self-reported understanding of providers and their employment at diabetes care clinics.

The survey population reported a high understanding of dietitian roles. However, the roles of other midlevel providers were not as well understood by youth with type 1 diabetes and their parents, which could represent a missed opportunity for care.