An assessment of nurse practitioner low-value care use in primary care

To establish baseline prevalence rates associated with nurse practitioner (NP) use of 3 of the most commonly observed primary care low-value-care (LVC) services and to examine whether practice location and patient characteristics impact NP LVC use.

Cross-sectional, secondary analysis.

Data for 14,579 adult beneficiaries in the 2021 Merative MarketScan Commercial and Medicare databases in Arizona, Nevada, and New Mexico were analyzed. Outpatient claims associated with NP care were used to examine the use of low-value lumbar x-ray, antibiotics for acute upper respiratory infection (aURI), and routine electrocardiogram (ECG) as described by the Choosing Wisely initiative. International Statistical Classification of Diseases, Tenth Revision and Current Procedural Terminology codes were used to apply inclusion and exclusion criteria. Relationships between LVC use and the state where a beneficiary received care, rural-urban practice location, and beneficiary sex and age were examined.

Prevalence rates of NP use of low-value lumbar x-ray (13%), aURI antibiotic (42%), and ECG (6%) were lower or relatively similar to those found in other studies. Older beneficiary age was significantly associated with more low-value ECGs used (P < .001), but when adults 45 years and older were examined, age no longer remained significantly related. No significant relationships between NP LVC use and practice location or beneficiary sex were found.

NP LVC use in primary care was lower or relatively similar compared with the general clinician population. MarketScan may underrepresent rural care, and the relationship between NP LVC use and rural-urban location should be reexamined using an alternative classification system. To deimplement NP LVC use, other factors, such as NP characteristics, must be explored.