Many U.S. states allow NPs to independently prescribe drugs, even though critics, often physician groups, maintain that quality of care will be adversely affected by the expansion of NP’s scope of practice.
A new study published in the Annals of Internal Medicine compared rates of inappropriate prescribing among NPs and primary care physicians.
The University of California Los Angeles–led research calculated rates of inappropriate prescribing and compared them for 23,669 NPs and 50,060 primary care physicians. Participants, who came from 29 states that had granted NPs prescribing authority by 2019, all wrote prescriptions for 100 or more patients per year, and the study team adjusted results for practice experience, patient volume and risk, clinical setting, year, and state.
The patients receiving prescriptions were all Medicare Part D beneficiaries aged 65 years or older from 2013 to 2019.
The focus was on 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 indicate that mean rates of inappropriate prescribing by NPs and primary care physicians were virtually identical (adjusted odds ratio, 0.99 [95% CI, 0.97-1.01]; 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,” the authors write. “For both types of practitioners, discrepancies in inappropriate prescribing rates across states tended to be larger than discrepancies between these practitioners within states.”
The researchers say their results might be limited because the Beers Criteria addresses the appropriateness of a selected subset of drugs and may not be valid in some clinical settings.
“Nurse practitioners were no more likely than physicians to prescribe inappropriately to older patients,” the study concludes “Broad efforts to improve the performance of all clinicians who prescribe may be more effective than limiting independent prescriptive authority to physicians.”
The study was funded by the Robert Wood Johnson Foundation and the National Science Foundation.
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