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To facilitate the teamwork of NPs and MDs while improving utilization of NPs as primary care providers, VHA officials should routinely clarify roles, monitor quality of care of both MDs and NPs, and provide feedback to all concerned.

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We examined the perceptions of nurse practitioners (NPs) and physicians regarding NPs' roles as primary care providers within the Department of Veterans Affairs, thus suggesting possible reasons for the variation of NPs use. NPs and physicians from 7 Veterans Affairs hospitals were surveyed regarding perceptions and concerns about NPs' responsibilities. Quality of care was verified through outpatient services, laboratory results, and medications prescribed for 104,226 hypertensive or diabetic patients. Clinical findings suggest primary care for diabetic and hypertensive patients was comparable. Survey findings suggest physicians tended to underestimate what NPs do on their own for acute patients. Both groups expressed some concerns about expectations for NPs. To successfully integrate NPs into the primary care environment, health systems need to pay increased attention to differences in role perceptions among primary care providers.

Purpose-This study's purpose is to examine whether a peer coaching intervention is more effective in improving clinical outcomes in diabetes when enhanced with e-Health educational tools than peer coaching alone. Methods-The effectiveness of peer coaches who used an individually tailored, interactive webbased tool (iDecide) was compared with peer coaches with no access to the tool. 290 Veterans Affairs patients with A1c>8.0% received a six-month intervention with an initial session with a fellow patient trained to be a peer coach followed by weekly phone calls to discuss behavioral