Opioid-prescribing Outcomes of Medicare Beneficiaries Managed by Nurse Practitioners and Physicians. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Muench, Ulrike; Spetz, Joanne; Jura, Matthew; Guo, Chaoran; Thomas, Cindy; Perloff, Jennifer
• Is Part Of: Medical care. Volume 57:Issue 6(2019)
• Publication Date: 2019-06
• Subjects: opioid prescribing -- nurse practitioners -- primary care -- Medicare part D; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001126
• Languages: English
• ISSNs: 0025-7079

Abstract

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. Abstract : Supplemental Digital Content is available in the text.