TY - JOUR
T1 - Differences in opioid prescribing among generalist physicians, nurse practitioners, and physician assistants
AU - Ellenbogen, Michael I.
AU - Segal, Jodi B.
N1 - Funding Information:
Funding sources: We would like to acknowledge support for the statistical analysis from the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health through grant number 1UL1TR001079. Dr. Segal is supported by the National Institute on Aging, grant K24AG049036.
Publisher Copyright:
© 2019 American Academy of Pain Medicine. All rights reserved.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Objective. To determine if there are differences in opioid prescribing among generalist physicians, nurse practitioners (NPs), and physician assistants (PAs) to Medicare Part D beneficiaries. Design. Serial cross-sectional analysis of prescription claims from 2013 to 2016 using publicly available data from the Centers for Medicare and Medicaid Services. Subjects. All generalist physicians, NPs, and PAs who provided more than 10 total prescription claims between 2013 and 2016 were included. These prescribers were subsetted as practicing in a primary care, urgent care, or hospital-based setting. Methods. The main outcomes were total opioid claims and opioid claims as a proportion of all claims in patients treated by these prescribers in each of the three settings of interest. Binomial regression was used to generate marginal estimates to allow comparison of the volume of claims by these prescribers with adjustment for practice setting, gender, years of practice, median income of the ZIP code, state fixed effects, and relevant interaction terms. Results. There were 36,999 generalist clinicians (physicians, NPs, and PAs) with at least one year of Part D prescription drug claims data between 2013 and 2016. The number of adjusted total opioid claims across these four years for physicians was 660 (95% confidence interval [CI] = 660–661), for NPs was 755 (95% CI = 753–757), and for PAs was 812 (95% CI = 811–814). Conclusions. We find relatively high rates of opioid prescribing among NPs and PAs, especially at the upper margins. This suggests that well-designed interventions to improve the safety of NP and PA opioid prescribing, along with that of their physician colleagues, could be especially beneficial.
AB - Objective. To determine if there are differences in opioid prescribing among generalist physicians, nurse practitioners (NPs), and physician assistants (PAs) to Medicare Part D beneficiaries. Design. Serial cross-sectional analysis of prescription claims from 2013 to 2016 using publicly available data from the Centers for Medicare and Medicaid Services. Subjects. All generalist physicians, NPs, and PAs who provided more than 10 total prescription claims between 2013 and 2016 were included. These prescribers were subsetted as practicing in a primary care, urgent care, or hospital-based setting. Methods. The main outcomes were total opioid claims and opioid claims as a proportion of all claims in patients treated by these prescribers in each of the three settings of interest. Binomial regression was used to generate marginal estimates to allow comparison of the volume of claims by these prescribers with adjustment for practice setting, gender, years of practice, median income of the ZIP code, state fixed effects, and relevant interaction terms. Results. There were 36,999 generalist clinicians (physicians, NPs, and PAs) with at least one year of Part D prescription drug claims data between 2013 and 2016. The number of adjusted total opioid claims across these four years for physicians was 660 (95% confidence interval [CI] = 660–661), for NPs was 755 (95% CI = 753–757), and for PAs was 812 (95% CI = 811–814). Conclusions. We find relatively high rates of opioid prescribing among NPs and PAs, especially at the upper margins. This suggests that well-designed interventions to improve the safety of NP and PA opioid prescribing, along with that of their physician colleagues, could be especially beneficial.
KW - Nurse Practitioners
KW - Opioid Prescribing
KW - Physician Assistant
KW - Primary Care
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U2 - 10.1093/pm/pnz005
DO - 10.1093/pm/pnz005
M3 - Article
C2 - 30821817
AN - SCOPUS:85077730641
SN - 1526-2375
VL - 21
SP - 76
EP - 83
JO - Pain Medicine (United States)
JF - Pain Medicine (United States)
IS - 1
ER -