Nurse practitioner low-value care ordering practices: an integrative review.

Area of Science:

• Healthcare Management
• Clinical Practice
• Health Economics

Background:

• Low-value care (LVC) services lack evidence, harm patients, and cost over $100 billion annually.
• Understanding nurse practitioner (NP) LVC ordering is crucial for reducing healthcare waste.
• This review examines NP LVC ordering in outpatient settings compared to other clinicians.

Approach:

• An integrative review was conducted using multiple electronic databases (PubMed, CINAHL, Web of Science, Business Source Complete) and Google Scholar.
• Searches included keywords related to LVC and NPs, with reference lists of included studies supplementing results.
• Twenty original studies published before April 2023 were included, with 7 assessed as low quality.

Key Points:

• Comparative data on NP LVC ordering versus other clinicians yielded conflicting results.
• NPs showed equal or varied rates of ordering antibiotics and lumbar imaging compared to physicians.
• NP specialization influenced LVC ordering, while scope of practice laws did not show a significant effect.

Conclusions:

• The full extent of NP LVC ordering and influencing factors remain largely unknown.
• It is uncertain if NPs order fewer or equal LVC services compared to other healthcare providers.
• Further research is essential to fully understand and address NP roles in LVC.