Does the “Office Nurse” Level of Training Matter in the Family Medicine Office?

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Figure 1.
Diabetes scores of dyads by nurse type. RN, registered nurse; LPN, licensed practical nurse; MA, medical assistant.

Table 1. Description of Practice by Location, Inclusion of Obstetrics, and Tenure (N = 55)

Practice Variable	Clinician Type		Clinical Associate Type
Practice Variable	Physician	Associate Provider	Registered Nurse	Licensed Practical Nurse	Medical Assistant
Total	43 (78.2%)	12 (11.8%)	8 (14.5%)	24 (43.6%)	23 (41.8%)
Nonrural (n = 24)	20 (36.4%)	4 (63.6%)	7 (12.7%)	12 (21.5%)	5 (9.1%)
Rural (n = 31)	23 (41.8%)	8 (14.5%)^*	1 (1.85)	12 (21.8%)	18 (32.7%)^†
Obstetrics (n = 20)	20 (36.4%)(15 rural)	0^‡	1 (1.85%)(0 rural)	12 (21.5%)(8 rural)	7 (12.5%)^§(7 rural)
No obstetrics (n = 35)	23 (41.8%)	12 (21.8%)	7 (12.7%)	12 (21.5%)	16 (29.1%)
Tenure, mean years ± standard deviation^¶	10.54 ± 1.09	10.64 ± 2.31	6.63 ± 1.71	6.57 ± 1.20	3.29 ± 0.48

Values provided as n (%) unless otherwise indicated.
↵* Clinician type by rural versus nonrural (P = .416).
↵† CA type by rural versus nonrural (P = .0038).
↵‡ Among family medicine clinicians, only physicians do obstetrics.
↵§ Clinical associate type by obstetrics versus no obstetrics (P = .120).
↵¶ Tenure for physicians was years of practice within the system. Tenure for clinical associates was years paired with clinician. Tenure was not significant by clinician type or for clinical associate type (P = .0525).

Table 2. Diabetic Performance Metrics^*

Group	Patients per Group (n)	Achieving All 5 Metrics^† (%)	Adjusted Odds Ratio (95% Confidence Interval)	P
Total	2584	18.5
Clinical associate type
LPN	1107	19.3	1.00	<.001
MA	1059	14.7	0.60 (0.44–0.81)
RN	418	27.8	1.37 (1.01–1.84)
Clinician type
AP	199	15.1	1.00	.022
MD/DO	2385	18.8	2.23 (1.23–4.41)
Site
Nonrural	1230	22.2	1.00	.78
Rural	1354	15.1	1.14 (0.82–1.57)
Inclusion of obstetrics
Not Included	1697	20.3	1.00	.011
Included	887	15.1	0.69 (0.51–0.92)

↵* Performance of diabetes care is measured by the percent of patients who meet all 5 criteria of the Minnesota Community Measures: tobacco nonuse, systolic blood pressure <130 mmHg and diastolic <80 mmHg, aspirin use if indicated, low-density lipoprotein cholesterol <100 mg/dL, and glycosylated hemoglobin <7.0%.
↵† Percents are unadjusted.
AP, associate provider; LPN, licensed practical nurse; MA, medical assistant; RN, registered nurse.

Table 3. Patient Satisfaction Scores

Group	Responses (n)	Positive Responses^* (%)	Adjusted Odds Ratio (95% Confidence Interval)	P
Associate type
LPN	9210	95.5	1.00	<.001
MA	9509	94.6	0.65 (0.53–0.80)
RN	3735	96.8	1.14 (0.88–1.48)
Provider type
AP	4244	93.2	1.00	<.001
MD/DO	17850	95.7	1.75 (1.41–2.17)
Site
Nonrural	10355	96.6	1.00	.0068
Rural	11729	94.1	0.65 (0.53–0.81)
Inclusion of obstetrics
Not included	14254	94.9	1.00	<.001
Included	7810	96.0	1.56 (1.27–1.93)

↵* Percent positive responses are those that rated the care they received as “good” or “very good” and negative responses would be those rating their care as “fair,” “poor,” or “very poor.”
AP, associate provider; LPN, licensed practical nurse; MA, medical assistant; RN, registered nurse.