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PA clinic for gestational diabetes: An observational study
Nikki Semaniuk1, Abigail Meadows, Pam Katz
1At the University of Manitoba in Winnipeg, Manitoba, Canada, Nikki Semaniuk is a clinical instructor for the Master of Physician Assistant Studies program; Abigail Meadows is a first-year medical resident; Pam Katz is an assistant professor in the Department of Internal Medicine and section head for the Section of Endocrinology; Sora Ludwig is a professor; Bruce Roe is an assistant professor of endocrinology and metabolism; Elizabeth Salamon is an assistant professor; Sarah M. Sigurdson is a first-year medical student; Katherine J. Bernier is a first-year medical student; Christy Pylypjuk is an associate professor and associate head of research in the Department of Obstetrics, Gynecology and Reproductive Sciences, as well as the assistant director of the Manitoba Obstetrical Outreach Program; and Jennifer M. Yamamoto is an assistant professor in the Department of Internal Medicine. Outside of the University of Manitoba, N. Semaniuk is an endocrinology PA at St. Boniface Hospital in Winnipeg; P. Katz is medical director of the Manitoba Adult Insulin Pump Program at Health Sciences Centre Winnipeg in Winnipeg; and J.M. Yamamoto is an adjunct assistant professor in the Department of Medicine at the University of Calgary in Calgary, Alberta, Canada. E. Salamon discloses receipt of monetary compensation from Novo Nordisk for educational sessions. C. Pylypjuk discloses receipt of grants to University of Manitoba and Health Sciences Centre Foundation for unrelated work. J.M. Yamamoto discloses receipt of devices for no or reduced cost from Abbott and Medtronic for investigator-initiated and publicly funded studies. The authors have disclosed no other potential conflicts of interest, financial or otherwise.
Objectives:
Gestational diabetes is a common complication of pregnancy. Its management requires diabetes expertise, prompt assessment, and frequent follow-up, all of which increasingly strains already overburdened specialty clinics. We aimed to assess the safety and effectiveness of a physician associate (PA)-led gestational diabetes clinic.
Methods:
We conducted a retrospective cohort study comparing outcomes between a PA-led interdisciplinary team clinic with a physician-led interdisciplinary team clinic.
Results:
After adjustment for differences in patient characteristics, maternal and neonatal outcomes were comparable between the clinic models. Initiation of pharmacotherapy was lower in the PA-led clinic group (adjusted odds ratio 0.19; 95% CI, 0.11-0.31), likely due to differences in referral triage process.
Conclusions:
The PA was able to manage half of the gestational diabetes referrals during the study period while maintaining a high level of care.
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