Influence of provider type on chronic pain prescribing patterns A systematic review.
Jacqueline Nikpour, Michelle Franklin, Nicole Calhoun and 1 others
PMID 34935726WHAT IT FOUND
Across 17 U.S. primary care studies, opioid prescribing patterns were similar between physicians, nurse practitioners and physician assistants.
Differences were inconsistent, and no study assessed nonpharmacologic strategies by provider type.
Key findings
01Family practice and internal medicine had the highest opioid prescribing rates compared with other specialties.
02Multiple included studies found NPs and PAs were as likely, or in some cases less likely, to prescribe opioids than physicians.
03Three included studies examined nonopioid medication prescribing across provider groups.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only 17 U.S. studies, and 13 focused solely on opioid prescriptions, so it says little about nonopioid or nonpharmacologic care. Most included studies used secondary claims data, and some identified NPs or PAs in ways that may have mixed primary care with higher prescribing specialties. The quality appraisal cut-off was 60%, and three included studies were low quality. Medicare incident-to billing may obscure care actually provided by NPs or PAs. Only one included study examined patient outcomes associated with opioid prescription rates.
Declared interests
The authors declared no competing interests. No funding source was stated in the supplied text.
The easy way to misread this
Do not conclude that nurse practitioners are safer opioid prescribers than physicians. The included studies found inconsistent differences, and several studies suggesting higher prescribing by NPs or PAs had limitations in how provider groups were identified.