Research Activities, November-December 2013
Regular primary care physicians are more likely to intensify medication for patients with diabetes
Patients with diabetes cared for by a regular primary care physician (PCP) are more likely to receive medication intensification (prescriptions for higher or more frequent doses of current drugs or addition of new medication) or lifestyle counseling on diet or exercise than patients treated by covering physicians (who filled in for the patient's regular PCP) or other medical providers (nurse practitioners or physician assistants), a new study finds.
As a result, patients seen more often by PCPs are likely to more quickly get their diabetes under control, that is, lower levels of blood sugar (glycated hemoglobin, HbA1c), and to more quickly lower their blood pressure and/or blood levels of low-density lipoprotein cholesterol than those seen frequently by covering physicians or midlevel practitioners.
During periods in which one or more of these measures were uncontrolled, patient encounters were mostly with PCPs (83 percent), less often with covering physicians (13 percent), and least often with midlevel providers (5 percent). Nearly half of the encounters (49 percent) were face-to-face visits rather than remote (telephone) consultations, and 19 percent involved an acute complaint (acute pain or infection). For all encounters, 11 percent resulted in medication intensification and 40 percent involved lifestyle counseling.
Using a model that controlled for patient demographics and clinical factors, the researchers determined that the probability of medication intensification and lifestyle counseling during nonacute encounters was 49 percent and 92 percent higher, respectively, for PCPs than for covering physicians and 27 percent and 22 percent higher, respectively, than for midlevel providers.
For encounters involving acute complaints, covering physicians were 50 percent less likely than PCPs to intensify medications, but midlevel providers were not significantly less likely to do so. Although midlevel practitioners were 39 percent less likely to give lifestyle counseling during an acute encounter, covering physicians were not significantly less likely to provide counseling.
The findings were based on data from 584,587 patient encounters documented via electronic medical records of 27,225 adults with diabetes treated for at least 2 years at primary care practices affiliated with two large teaching hospitals in Boston. The study was funded in part by AHRQ (HS17030).
More details are in "Performance of primary care physicians and other providers on key process measures in the treatment of diabetes," by Fritha Morrison, M.P.H., Maria Schubina, Sc.D., Saveli I. Goldberg, Ph.D., and others in the May 2013 Diabetes Care 36(5), pp. 1147-1152.