Opioid-prescribing Outcomes of Medicare Beneficiaries Managed by Nurse Practitioners and Physicians
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AbstractBackground: Primary care providers are at the center of the opioid epidemic. Whether nurse practitioners (NPs) have different opioid-prescribing outcomes from physicians is not known.

Objective: To examine opioid-prescribing outcomes of Medicare beneficiaries receiving care from NPs and physicians in primary care.

Research Design: We used Medicare data from 2009 to 2013 and a propensity score-weighted analysis.

Subjects: Beneficiaries residing in states in which NPs are able to prescribe controlled substances without physician oversight and who did not have a cancer diagnosis, hospice care, or end-stage renal disease.

Measures: First, we measured whether beneficiaries received any opioid prescription. Second, for beneficiaries who received opioids, we measured acute (< 90 d supply) and chronic (>= 90 d supply) use at baseline (2009-2010) and follow-up (2012-2013). Third, we measured potential misuse of opioid prescribing using a daily morphine milligram equivalent dose of >100 mg, overlapping prescriptions of opioids >7 days, and overlapping prescriptions of opioids with benzodiazepines >7 days.

Results: Beneficiaries managed by NPs were less likely to receive an opioid [odds ratio (OR), 0.87; P<0.001], were less likely to be acute users at baseline (OR, 0.84; P<0.001), and were more likely to receive a high daily opioid dose of morphine milligram equivalent > 100 mg compared with physician-managed beneficiaries (OR, 1.11; P=0.048).

Conclusions: Findings suggest educational programs and clinical guidelines may require approaches tailored to different providers. Future research should examine the contributing factors of these patterns to ensure high-quality pain management and guide policy makers on NP-controlled substance-prescribing regulations.
All Author(s) ListMuench U, Spetz J, Jura M, Guo CR, Thomas C, Perloff J
Journal nameMedical Care
Volume Number57
Issue Number6
Pages482 - 489
LanguagesEnglish-United Kingdom
Keywordsopioid prescribing, nurse practitioners, primary care, Medicare part D
Web of Science Subject CategoriesHealth Care Sciences & Services;Health Policy & Services;Public, Environmental & Occupational Health;Health Care Sciences & Services;Public, Environmental & Occupational Health

Last updated on 2021-19-09 at 00:04