Is prescribing by PAs and NPs comparable to physician prescribing?

Area of Science:

• Health Services Research
• Pharmacology
• Clinical Practice

Background:

• Physician assistants (PAs) and nurse practitioners (NPs) possess broad prescribing authority in the U.S.
• Limited data exists on the comparative quality of prescribing practices between PAs, NPs, and physicians.

Purpose of the Study:

• To investigate and compare the quality of prescribing practices among physicians, PAs, and NPs.
• To evaluate adherence to quality indicators in ambulatory care settings.

Main Methods:

• Serial cross-sectional analysis using 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) data.
• Evaluation of 13 validated outpatient quality indicators for chronic disease pharmacologic management and appropriate medication use.
• Nationally representative sample of patient visits to physicians, PAs, and NPs in various ambulatory care settings.

Main Results:

• Physicians provided care for 96.8% of outpatient visits; PAs and NPs each accounted for 1.6%.
• Overall performance across quality indicators showed significant variation, with a median of 58.7%.
• After adjusting for confounders, prescribing quality by PAs and NPs was similar to physicians for 10 of 13 indicators.

Conclusions:

• The quality of ambulatory prescribing demonstrates significant shortfalls across all practitioner types.
• Prescribing quality by PAs and NPs is generally comparable to that of physicians.
• No consistent directional association was found between provider type and prescribing quality for remaining measures.