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Inappropriate Prescribing to Older Patients by NPs, PCPs

In a study of inappropriate prescribing to older adults, nurse practitioners (NPs) and primary care physicians performed similarly, researchers report. “Broad efforts to improve the performance of all clinicians who prescribe may be more effective than limiting independent prescriptive authority to physicians,” the authors conclude.

The researchers focused on the 29 states that had granted NPs prescriptive authority by 2019. Among 23,669 NPs and 50,060 primary care physicians who wrote prescriptions for 100 or more patients per year, Medicare Part D prescriptions for inappropriate drugs in the American Geriatrics Society Beers Criteria were identified for beneficiaries aged 65 years or older were identified years or older in 2013 to 2019.

“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),” the authors write. “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.”

“The authors’ findings add to a long list of empirical work showing that NPs provide equal or better quality of care when compared with their physician colleagues in primary care,” editorialists write. “As scope of practice debates continue to rage, Huynh and colleagues’ analyses find that NPs are providing a greater proportion of care to older adults outside of large metropolitan areas, many of whom would likely have no other source of primary care. There are nearly 100 million persons living in 8,267 health professional shortage areas in the United States where there are insufficient primary care providers to meet health care needs. Nurse practitioners will continue to serve critical roles in ensuring that older adults in areas with inadequate numbers of health care providers receive primary care. Our goal should be to reduce variation and improve prescribing quality among all clinicians who care for older adults.”

Source: Annals of Internal Medicine