Nurse Practitioner Care Compared with Primary Care or Nephrologist Care in Early CKD

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Abstract

Background Early interventions in CKD have been shown to improve health outcomes; however, gaps in access to nephrology care remain common. Nurse practitioners can improve access to care; however, the quality and outcomes of nurse practitioner care for CKD are uncertain. Methods In this propensity score–matched cohort study, patients with CKD meeting criteria for nurse practitioner care were matched 1:1 on their propensity scores for (1) nurse practitioner care versus primary care alone and (2) nurse practitioner versus nephrologist care. Processes of care were measured within 1 year after cohort entry, and clinical outcomes were measured over 5 years of follow-up and compared between propensity score–matched groups. Results A total of 961 (99%) patients from the nurse practitioner clinic were matched on their propensity score to 961 (1%) patients receiving primary care only while 969 (100%) patients from the nurse practitioner clinic were matched to 969 (7%) patients receiving nephrologist care. After matching to patients receiving primary care alone, those receiving nurse practitioner care had greater use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (82% versus 79%; absolute differences [ADs] 3.4% [95% confidence interval, 0.0% to 6.9%]) and statins (75% versus 66%; AD 9.7% [5.8% to 13.6%]), fewer prescriptions of nonsteroidal anti-inflammatory drugs (10% versus 17%; AD –7.2% [210.4% to 24.2%]), greater eGFR and albuminuria monitoring, and lower rates of all-cause hospitalization (34.1 versus 43.3; rate difference 29.2 [214.7 to 23.8] per 100 person-years) and all-cause mortality (3.3 versus 6.0; rate difference 22.7 [23.6 to 21.7] per 100 person-years). When matched to patients receiving nephrologist care, those receiving nurse practitioner care were also more likely to be prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and statins, with no difference in the risks of experiencing adverse clinical outcomes. Conclusions Nurse practitioner care for patients with CKD was associated with better guideline-concordant care than primary care alone or nephrologist care, with clinical outcomes that were better than or equivalent to primary care alone and similar to those with care by nephrologists.

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CITATION STYLE

APA

James, M. T., Scory, T. D., Novak, E., Manns, B. J., Hemmelgarn, B. R., Bello, A. K., … Ronksley, P. E. (2023). Nurse Practitioner Care Compared with Primary Care or Nephrologist Care in Early CKD. Clinical Journal of the American Society of Nephrology, 18(12), 1533–1544. https://doi.org/10.2215/CJN.0000000000000305

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