Nurse practitioners as safe as physicians in prescribing medication for older patients, study finds | News Center

The researchers found that both groups averaged approximately 1.7 inappropriate prescriptions for every 100 prescriptions written. However, nurse practitioners were overrepresented among clinicians with the highest and the lowest rates of inappropriate prescribing.

“Although we found that the average rate of inappropriate prescribing among NPs and physicians was similar, we also found that NPs were over-represented among the best performers and the worst performers,” Huynh said. “Those lower performers warrant attention from the hospitals, clinics and professional regulators that oversee their care.”

The researchers identified substantial variation in prescribing quality in the 29 states, finding that the variation from one state to another was much larger than the differences in quality between nurse practitioners and primary care physicians in any given state.

Addressing a shortage

Health care analysts predict the shortfall of primary care physicians in the United States could reach 48,000 in the next decade as primary care physicians approach retirement and medical students burdened with student loans are choosing specialties with higher salaries and lower administrative costs. This deficit will inevitably demand greater use of nurse practitioners and other nonphysician providers to fill gaps in primary care services.

Regardless, the American Medical Association and other professional medical organizations have staunchly opposed laws that allow nonphysician prescribing. They claim such “scope creep” — widening the scope of someone’s duties — will adversely affect quality of care.

But the researchers concluded that addressing unsafe prescribing among all providers should be the focus. In their study, they wrote, “If expanding patient access while ensuring quality and safety systemwide is the goal, fixation on the question of whether NPs or other nonphysician providers should be allowed to prescribe may be less impactful than identifying and addressing deficient performance among all clinicians who prescribe, regardless of practitioner type or practice location.”

The report describes various interventions with strong potential to improve prescribing, including clinician-level performance measures, prescription drug monitoring systems and initiatives aimed at ensuring better adherence to trusted guidelines such as the Beers Criteria.

An accompanying editorial from authors at UCLA suggests that rates of inappropriate prescribing are too high among practitioners of all stripes, and that the health policy goal should be to improve prescribing quality among all clinicians who care for older adults.

“States that are holding off conferring prescriptive authority on nurse practitioners because of concerns about quality of care should think again,” Huynh said.