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Med Care. 2019 Jun;57(6):482-489. doi: 10.1097/MLR.0000000000001126.

Opioid-prescribing Outcomes of Medicare Beneficiaries Managed by Nurse Practitioners and Physicians.

Author information

1
Department of Social and Behavioral Sciences, School of Nursing.
2
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.
3
Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan.
4
The Chinese University of Hong Kong, Shatin, N.T. Hong Kong.
5
The Heller School, Brandeis University, Waltham, MA.

Abstract

BACKGROUND:

Primary care providers are at the center of the opioid epidemic. Whether nurse practitioners (NPs) have different opioid-prescribing outcomes from physicians is not known.

OBJECTIVE:

To examine opioid-prescribing outcomes of Medicare beneficiaries receiving care from NPs and physicians in primary care.

RESEARCH DESIGN:

We used Medicare data from 2009 to 2013 and a propensity score-weighted analysis.

SUBJECTS:

Beneficiaries residing in states in which NPs are able to prescribe controlled substances without physician oversight and who did not have a cancer diagnosis, hospice care, or end-stage renal disease.

MEASURES:

First, we measured whether beneficiaries received any opioid prescription. Second, for beneficiaries who received opioids, we measured acute (<90 d supply) and chronic (≥90 d supply) use at baseline (2009-2010) and follow-up (2012-2013). Third, we measured potential misuse of opioid prescribing using a daily morphine milligram equivalent dose of >100 mg, overlapping prescriptions of opioids >7 days, and overlapping prescriptions of opioids with benzodiazepines >7 days.

RESULTS:

Beneficiaries managed by NPs were less likely to receive an opioid [odds ratio (OR), 0.87; P<0.001], were less likely to be acute users at baseline (OR, 0.84; P<0.001), and were more likely to receive a high daily opioid dose of morphine milligram equivalent >100 mg compared with physician-managed beneficiaries (OR, 1.11; P=0.048).

CONCLUSIONS:

Findings suggest educational programs and clinical guidelines may require approaches tailored to different providers. Future research should examine the contributing factors of these patterns to ensure high-quality pain management and guide policy makers on NP-controlled substance-prescribing regulations.

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