Potentially inappropriate medication prescribing by nurse practitioners and physicians.
Aged
Aged, 80 and over
Ambulatory Care
/ statistics & numerical data
Female
Hospitalization
/ statistics & numerical data
Humans
Inappropriate Prescribing
/ statistics & numerical data
Male
Medicare
Nurse Practitioners
/ statistics & numerical data
Odds Ratio
Physicians
/ statistics & numerical data
Risk Factors
Texas
United States
nurse practitioners
potentially inappropriate medication
quality of prescribing
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
revised:
06
02
2021
received:
30
10
2020
accepted:
03
03
2021
pubmed:
23
3
2021
medline:
12
10
2021
entrez:
22
3
2021
Statut:
ppublish
Résumé
Potentially inappropriate medication (PIM) use is a risk factor for hospitalization and mortality. However, there were few studies focusing on the impact of provider type on PIM use. We aimed to estimate the initial and refill PIM prescribing rate for physician visits and nurse practitioner (NP) visits and the impact of provider type on PIM prescribing. We used 100% Texas Medicare data to define physician visits and NP visits in 2016. The rate of visits with a PIM prescription from the same provider was measured, distinguishing between initial and refill prescription to estimate the PIM rate and adjusted odds ratio (OR) by provider type. There were 24.1 per 1000 visits with a prescription for a PIM: 9.0 per 1000 visits for an initial PIM and 15.1 per 1000 visits for a refill PIM. A visit to an NP was less likely to result in an initial (OR = 0.74, 95% confidence interval [CI] = 0.70-0.79) or refill (OR = 0.54, 95% CI = 0.51-0.57) PIM. The association of lower odds of receiving a prescription for an initial PIM from an NP was substantially stronger among black enrollees than white enrollees (OR = 0.44, 95%CI = 0.30-0.65 for blacks and OR = 0.73, 95%CI = 0.68-0.78 for white enrollees). The association of an NP provider with lower odds of receiving a PIM refill was more pronounced in older patients and in those with more comorbidities. NPs prescribed fewer initial PIMs and were less likely to refill a PIM after an outpatient visit than physicians. The lower odds of receiving PIMs during an NP visit varied by age, race/ethnicity, rurality, and number of comorbidities.
Sections du résumé
BACKGROUND
Potentially inappropriate medication (PIM) use is a risk factor for hospitalization and mortality. However, there were few studies focusing on the impact of provider type on PIM use.
OBJECTIVE
We aimed to estimate the initial and refill PIM prescribing rate for physician visits and nurse practitioner (NP) visits and the impact of provider type on PIM prescribing.
RESEARCH DESIGN
We used 100% Texas Medicare data to define physician visits and NP visits in 2016. The rate of visits with a PIM prescription from the same provider was measured, distinguishing between initial and refill prescription to estimate the PIM rate and adjusted odds ratio (OR) by provider type.
RESULTS
There were 24.1 per 1000 visits with a prescription for a PIM: 9.0 per 1000 visits for an initial PIM and 15.1 per 1000 visits for a refill PIM. A visit to an NP was less likely to result in an initial (OR = 0.74, 95% confidence interval [CI] = 0.70-0.79) or refill (OR = 0.54, 95% CI = 0.51-0.57) PIM. The association of lower odds of receiving a prescription for an initial PIM from an NP was substantially stronger among black enrollees than white enrollees (OR = 0.44, 95%CI = 0.30-0.65 for blacks and OR = 0.73, 95%CI = 0.68-0.78 for white enrollees). The association of an NP provider with lower odds of receiving a PIM refill was more pronounced in older patients and in those with more comorbidities.
CONCLUSIONS
NPs prescribed fewer initial PIMs and were less likely to refill a PIM after an outpatient visit than physicians. The lower odds of receiving PIMs during an NP visit varied by age, race/ethnicity, rurality, and number of comorbidities.
Identifiants
pubmed: 33749843
doi: 10.1111/jgs.17120
pmc: PMC8273104
mid: NIHMS1684891
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1916-1924Subventions
Organisme : NIA NIH HHS
ID : P30 AG024832
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS020642
Pays : United States
Organisme : NIA NIH HHS
ID : P30-AG024832
Pays : United States
Organisme : AHRQ HHS
ID : R01HS020642
Pays : United States
Informations de copyright
© 2021 The American Geriatrics Society.
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