Nurse practitioners prescribe as safely as physicians: study

Nurse practitioners and physicians are similarly likely to inappropriately prescribe medications to older patients, new research from the US reveals.

The research, involving 73,000 primary care physicians (PCPs) and nurse practitioners (NPs), studied older patients living in states where nurse practitioners were able to prescribe medications independently during the study period.

The findings add to growing evidence indicating that when prescriptive authority is expanded to include NPs, these new prescribers do not perform worse than physicians, the authors said.

The research comes at an interesting time, when Australian residential aged care homes are required to deliver at least 200 care minutes per resident per day, including 40 minutes with a registered nurse.  These care minutes are the direct care time delivered by registered nurses, enrolled nurses and personal care workers, including nursing assistants.

Medication management and safety has already been identified as an important improvement area by The Royal Commission into Aged Care Quality and Safety, with the government announcing a national rollout of embedded onsite pharmacists in government-funded residential aged care facilities (RACFs) in 2022.

The US study calculated inappropriate prescribing rates for 23,669 NPs and 50,060 PCPs prescribing medications to patients aged 65 years and older across 29 states that have granted NPs prescriptive authority. The study, by researchers from the University of California, Los Angeles, Yale Law School and Stanford University, used the American Geriatrics Society’s Beers Criteria for inappropriate prescribing.

The researchers found that both PCPs and NPs averaged approximately 1.7 inappropriate prescriptions for every 100 prescriptions written. However, NPs were overrepresented among clinicians with the highest and the lowest rates of inappropriate prescribing.

According to the authors, these findings provide useful lessons for policymakers, lawmakers and regulators. The authors note that NPs are providing a greater proportion of care to older adults outside of large metropolitan areas, many of whom would likely have no other source of primary care. They also emphasise that NPs will continue to serve critical roles in ensuring that older adults in areas with inadequate numbers of healthcare providers receive primary care. The goal of clinicians should be to reduce variation and improve prescribing quality among all clinicians who care for older adults.

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