Patient demographics and clinical characteristics influence opioid and nonopioid pain management prescriptions of primary care NPs, PAs, and physicians.
Jacqueline Nikpour, Marion Broome, Susan Silva and 1 others
PMID 35544348WHAT IT FOUND
Patient traits, not provider type, were linked to opioid and nonopioid prescriptions in 39,936 veterans with chronic musculoskeletal pain.
White, age 41-64, no postsecondary education, fair/poor health, and 5+ comorbidities had higher opioid odds; Black, younger than 65, and female patients had higher nonopioid odds.
Key findings
01In 39,936 patients, no statistically significant patient characteristics-by-provider-group interactions were found for opioid or nonopioid prescriptions (all p-values > .05).
02Patients who were White, aged 41-64 years, had no postsecondary education, self-reported fair/poor health, had multiple chronic pain diagnoses, or had 5+ Elixhauser comorbidities had significantly higher odds of an opioid prescription.
03Patients who were Black, younger than 65 years, female, self-reported fair/poor health or fair/poor mental health, had multiple chronic pain diagnoses, or had 5+ Elixhauser comorbidities had significantly higher odds of a nonopioid prescription.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
It was a correlational secondary analysis, so it shows associations rather than proof that patient characteristics caused prescribing differences. The authors noted the data were limited by their age and that the VA issued new guidelines in 2017. Patients with liver failure, renal failure, or cancer, and patients in eight states where NPs and PAs could not prescribe opioids, were excluded. The study looked only at whether prescriptions were present, not dose, duration, or pain outcomes. It could not assess nonpharmacologic pain management therapies such as referrals to physical therapy. Findings are generalizable only to the VA system.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not conclude that nurse practitioners or physician assistants prescribe opioids differently from physicians. The study found no significant patient-characteristic-by-provider-group interactions, and it was correlational, so it cannot show that patient characteristics caused the prescribing differences.