Pharmaceutical Industry Sponsorship and the NP Prescriber: Policy and Practice Implications

Prescribing by Physician Associates and Nurse Practitioners in Older Adults Is Outpacing Traditional Prescribers: Implications for Practice in American Medicine

Prescribing is a significant activity undertaken by physicians, physician associates/assistants (PAs), and nurse practitioners (NPs). We analyzed prescribing data to understand better the growing presence of PAs and NPs in older adults. A trend in frequently prescribed medications was compared with other physicians. All prescriptions in Medicare Part D were grouped into broad categories of drugs and linked to each type of provider. The analysis spanned 9 years (2013-2021). The results revealed that all five providers similarly prescribed the top three main drug classes (antacids, antihypertensives, and statins). In addition, there was a decline in the number of unique prescribers and prescriptions for all three types of physicians (family medicine, internal medicine, and general practice physicians). Concurrently, the number and share of prescriptions for NPs and PAs increased yearly. The findings are consistent with data that PAs and NPs are backfilling physician shortages in treating older adults.

Nurse practitioner continuing education: exploring influences

PURPOSE

This article introduces the interrelated concepts of nurse practitioner (NP) continuing education (CE) funding patterns, regulatory guidance surrounding NP CE, and its effect on patient outcomes in the United States.

DATA SOURCES

A literature review was done by searching online databases: MEDLINE and CINAHL. Searches included review of NP certifying body websites, Institute of Medicine, Josiah Macy Foundation, and the National Council of State Boards of Nursing websites.

CONCLUSIONS

The nursing literature supports no connection between required CE and improvement in provision of care to patients, nor does it support improvement in individual provider competence. The funding patterns for nursing and medicine indicate a bias toward biomedical and pharmacological interventions. This type of funding stream may contribute to practice gaps rather than improve them.

IMPLICATIONS FOR PRACTICE

Understanding factors that influence CE program availability, plus the choices NPs make regarding mandatory CE, can provide planning guidance. This guidance can help reach the goal of improved patient outcomes and decreased healthcare disparities as a result of CE interventions. NP-specific findings may potentially influence regulatory reform relevant to mandatory CE and maintenance of certification. It is important that NPs recognize existing conflicts of interest in order to make informed program choices.

Pharmaceutical speakers' bureaus, academic freedom, and the management of promotional speaking at academic medical centers

Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver "educational" talks to groups of physicians in the community to help market the company's brand-name drugs. Although presented as educational, and even though they provide educational content, these events are intended to influence decisions about drug selection in ways that are not based on the suitability and effectiveness of the product, but on the prestige and persuasiveness of the speaker. A number of state legislatures and most academic medical centers have attempted to restrict physician participation in pharmaceutical marketing activities, though most restrictions are not absolute and have proven difficult to enforce. This article reviews the literature on why Speakers' Bureaus have become a lightning rod for academic/industry conflicts of interest and examines the arguments of those who defend physician participation. It considers whether the restrictions on Speakers' Bureaus are consistent with principles of academic freedom and concludes with the legal and institutional efforts to manage industry speaking.