Nurse practitioner's independent prescriptive authority and opioids abuse

Scope of practice and opioid prescribing behavior of nurse practitioners serving Medicare beneficiaries

Policymakers aiming to increase access to health care while simultaneously keeping costs low and quality high are considering expanding the practice authority and prescriptive authority of nurse practitioners in order to address primary care shortages. While we know this increases access, some researchers argue that the expansion of job autonomy of nurse practitioners can compromise the quality and safety of rendered medical services. This paper investigates quality and safety outcomes in prescribing behaviors of nurse practitioners who have prescribed opioids for Medicare Part D beneficiaries using a unique source of policy variation, nurse practitioners with the ability to prescribe medication who move to either states with or without physician supervision. We find that scope of practice expansions do not compromise quality and safety in terms of potential abuse or misuse of prescriptive authority.

Health outcomes and provider choice under full practice authority for certified nurse-midwives

Full practice authority grants non-physician providers the ability to manage patient care without physician oversight or direct collaboration. In this study, we consider whether full practice authority for certified nurse-midwives (CNMs/CMs) leads to changes in health outcomes or CNM/CM use. Using U.S. birth certificate and death certificate records over 2008-2019, we show that CNM/CM full practice authority led to little change in obstetric outcomes, maternal mortality, or neonatal mortality. Instead, full practice authority increases (reported) CNM/CM-attended deliveries by one percentage point while decreasing (reported) physician-attended births. We then explore the mechanisms behind the increase in CNM/CM-attended deliveries, demonstrating that the rise in CNM/CM-attended deliveries represents higher use of existing CNM/CMs and is not fully explainable by improved reporting of CNM/CM deliveries or changes in CNM/CM labor supply.

Nurse Practitioner Scope-of-Practice Laws and Opioid Prescribing

Policy Points The increased use of nurse practitioners represents a viable policy option to address continuing access-to-care deficiencies across the United States, but state scope-of-practice laws limit the ability of nurse practitioners to deliver health care. Groups in favor of restrictive scope-of-practice laws have argued that relaxing these laws will lead to increases in opioid prescriptions during an already severe opioid crisis, implicating patient safety concerns. An examination of a data set of 1.5 billion opioid prescriptions demonstrates that relaxing nurse practitioner scope-of-practice laws generally reduces opioid prescriptions. This evidence supports eliminating restrictive scope-of-practice laws that currently govern nurse practitioners in many states.

CONTEXT

As many parts of the United States continue to face physician shortages, the increased use of nurse practitioners (NPs) can improve access to care. However, state scope-of-practice (SOP) laws limit the ability of NPs to provide care by restricting the services they can provide and often requiring physician supervision of their practices. One important justification for the continuation of these restrictive SOP laws is preventing the overprescription of certain medications, particularly opioids.

METHODS

This study examined a data set of approximately 1.5 billion individual opioid prescriptions between 2011 and 2018, which were aggregated to the individual provider-year level. A series of difference-in-differences regression models was estimated to examine the association between laws allowing NPs to practice independently and opioid prescribing patterns among physicians and NPs. Opioid prescriptions were measured in total annual morphine milligram equivalents (MMEs) prescribed by individual providers.

FINDINGS

Across all NPs and physicians, independent NP practice was associated with a statistically significant decline of 6%, 2%, 3%, 7%, and 5% in total annual MMEs prescribed to commercially insured, cash-paying, Medicare, government-assistance, and all patients, respectively. Medicaid patients saw no statistically significant change in annual MMEs. Across all payers, NPs generally increase and physicians generally decrease the number of opioids they prescribe following a grant of NP independence. These counterbalancing changes result in an overall net decline in MMEs.

CONCLUSIONS

No evidence supports the contention that allowing NPs to practice independently increases opioid prescriptions. The results support policy changes that allow NPs to practice independently.

Exploratory descriptive analysis of opioid prescribing prevalence of nurse practitioners and the specialties associated with the top prescribers

BACKGROUND

Opioid prescription drug abuse is increasingly becoming a concern beyond the United States. Little is known regarding nurse practitioners' opioid prescribing patterns or settings.

AIM

To examine nurse practitioners' opioid prescription patterns.

METHODS

We conducted a retrospective cross-sectional descriptive study of the 2016 Medicare Part D Prescriber Public Use File and analysed the association between the number of nurse practitioners and the number of opioid prescriptions. We conducted Web searches on the top 1% of prescribers to obtain the specialty areas in which nurse practitioners worked.

RESULTS

There was no significant correlation between the prevalence of nurse practitioners and the opioid prescription rates among the states in the United States. Most nurse practitioners do not prescribe opioids. Opioid prescription is highly concentrated among nurse practitioners, as 1% of nurse practitioners account for one third of opioids prescribed by nurse practitioners. Most of the top 1% opioid prescribers practice in specialty care with board-certified pain medicine physicians.

CONCLUSIONS

The prevalence of nurse practitioners is not likely a significant contributing factor to the opioid epidemic. Rather than increased scrutiny of opioid prescribing, a better approach to curb the opioid crisis might be to facilitate collaboration among physicians, nurse practitioners and patients.