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- Title
Inappropriate Prescribing to Older Patients by Nurse Practitioners and Primary Care Physicians.
- Authors
Huynh, Johnny; Alim, Sahil A.; Chan, David C.; Studdert, David M.
- Abstract
Many states have enacted laws to increase the autonomy of nonphysician providers. For example, 32 states and the District of Columbia now allow nurse practitioners (NPs) to prescribe medications without physician supervision. Professional medical organizations have opposed these laws by raising concerns about adverse effects on the quality of care. Published studies were relatively small and unable to confirm these concerns. This larger study compares the prescribing patterns of physicians and NPs in the 29 states where NPs had the authority to prescribe during 2013 to 2019. Visual Abstract. Inappropriate Prescribing to Older Patients by Nurse Practitioners and Primary Care Physicians: Many states have enacted laws to increase the autonomy of nonphysician providers. For example, 32 states and the District of Columbia now allow nurse practitioners (NPs) to prescribe medications without physician supervision. Professional medical organizations have opposed these laws by raising concerns about adverse effects on the quality of care. Published studies were relatively small and unable to confirm these concerns. This larger study compares the prescribing patterns of physicians and NPs in the 29 states where NPs had the authority to prescribe during 2013 to 2019. Background: Many U.S. states have legislated to allow nurse practitioners (NPs) to independently prescribe drugs. Critics contend that these moves will adversely affect quality of care. Objective: To compare rates of inappropriate prescribing among NPs and primary care physicians. Design: Rates of inappropriate prescribing were calculated and compared for 23 669 NPs and 50 060 primary care physicians who wrote prescriptions for 100 or more patients per year, with adjustment for practice experience, patient volume and risk, clinical setting, year, and state. Setting: 29 states that had granted NPs prescriptive authority by 2019. Patients: Medicare Part D beneficiaries aged 65 years or older in 2013 to 2019. Measurements: Inappropriate prescriptions, defined as drugs that typically should not be prescribed for adults aged 65 years or older, according to the American Geriatrics Society's Beers Criteria. Results: Mean rates of inappropriate prescribing by NPs and primary care physicians were virtually identical (adjusted odds ratio, 0.99 [95% CI, 0.97 to 1.01]; crude rates, 1.63 vs. 1.69 per 100 prescriptions; adjusted rates, 1.66 vs. 1.68). However, NPs were overrepresented among clinicians with the highest and lowest rates of inappropriate prescribing. For both types of practitioners, discrepancies in inappropriate prescribing rates across states tended to be larger than discrepancies between these practitioners within states. Limitation: The Beers Criteria addresses the appropriateness of a selected subset of drugs and may not be valid in some clinical settings. Conclusion: Nurse practitioners were no more likely than physicians to prescribe inappropriately to older patients. Broad efforts to improve the performance of all clinicians who prescribe may be more effective than limiting independent prescriptive authority to physicians. Primary Funding Source: The Robert Wood Johnson Foundation and National Science Foundation.
- Subjects
WASHINGTON (D.C.); INAPPROPRIATE prescribing (Medicine); NURSE practitioners; ROBERT Wood Johnson Foundation; NATIONAL Science Foundation (U.S.); AMERICAN Geriatrics Society; OLDER patients; NURSES as patients; NURSE prescribing; PHYSICIANS; NURSE-patient relationships
- Publication
Annals of Internal Medicine, 2023, Vol 176, Issue 11, p1448
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/M23-0827