Low-density lipoprotein cholesterol control rates in the type-2 diabetic patient population within independent nurse practitioner settings.

PURPOSE: The purposes of this study were to describe the low-density lipoprotein cholesterol (LDL-C) control rate of patients with type-2 diabetes mellitus (DM2) treated by nurse practitioner (NP) providers, and to describe any significant differences in the population at the LDL-C goal of <100 mg/dL and patients not at goal. DATA SOURCES: Demographic data were collected from a retrospective chart review of patients with (DM2) who were treated in two primary care NP practice settings in New Hampshire where physician collaboration is not required. Data regarding smoking history, lifestyle, comorbidities, and antilipid and antidiabetes medication were collected. Physiological measurements included the body mass index (BMI), hemoglobin A1c (A1c), and the LDL-C. CONCLUSIONS: Patients with DM2 treated by NP providers were at goal with respect to the LDL-C in 71% of the cases in this study. Statin therapy was prescribed in 60.5% of the cases. Lifestyle management was recommended 92.6% of the time. IMPLICATIONS FOR PRACTICE: NPs prescribe appropriate medications, order and monitor laboratory values, in addition to providing education regarding lifestyle changes to patients with chronic diseases. Reported outcomes achieved by NP providers validate them as evidenced-based providers of quality care for patients with complex diseases such as DM2.

Hypertension treatment and control within an independent nurse practitioner setting.

OBJECTIVE: To assess blood pressure (BP) control among patients with hypertension managed by nurse practitioners (NPs) vs physicians. STUDY DESIGN: Cross-sectional study. METHODS: Retrospective medical record reviews were conducted at 3 independent NP-based practices and at 21 physician-based practices. Investigators at each practice identified a sample of patients 18 years or older with a hypertension diagnosis. The primary outcome was controlled BP (<140/90 mm Hg for patients without diabetes mellitus and <130/80 mm Hg for patients with diabetes mellitus). Propensity score matching was used to minimize potential selection bias between NP-treated and physician-treated patients and to balance differences in patient characteristics. Logistic regression analysis was performed to estimate the odds of controlled BP for NP-treated vs physician-treated patients, adjusting for covariates. RESULTS: The NP-treated sample was composed of 684 patients; their mean age was 54.2 years, 62.6% were female, 59.7% were obese, and 19.2% had diabetes mellitus. Before propensity score matching, physician-treated patients were older, less likely to be female, and more likely to have diabetes. The propensity score-matched cohort (n = 623 in each group) had similar baseline characteristics. Among the NP cohort, 70.5% had controlled BP compared with 63.2% among the physician cohort; the mean number of antihypertensive medications was lower among NP-treated patients (1.6 vs 1.8, P = .01). The adjusted odds of controlled BP were slightly lower for physician-treated patients (odds ratio, 0.76; 95% confidence interval, 0.58-0.99). CONCLUSIONS: Comparable controlled BP rates were observed among patients with hypertension receiving care from an NP vs a comparison group receiving care from a physician; the groups had similar baseline characteristics. Our findings support the increasingly important role of NPs in primary care.