SPOILER ALERT:
Supervised practice works – truly unsupervised NPs are an extreme minority in the study (estimated at 3%). NPs were overrepresented among clinicians with the highest and lowest rates of inappropriate prescribing. Does this just average things out? Who were the ones who did well, and who did poorly? More questions than answers.
SUMMARY:
In today’s episode, Teresa Camp-Rogers, MD, MS analyzes a study published in the Annals of Internal Medicine, the journal of the American College of Physicians, entitled ‘Inappropriate Prescribing to Older Patients by Nurse Practitioners and Primary Care Physicians.’ The article, which seems to call for an expansion of unsupervised practice for NPs, contends that NPs and physicians showed no differences in inappropriate prescribing to seniors based on Beers criteria, however, notes that NPs were overrepresented among clinicians with the highest and lowest rates of inappropriate prescribing. Dr. Camp-Rogers points out that since most NPs are practicing under physician supervision, with an estimated 2-6% of NPs practicing without physician supervision, this study may simply prove what other studies have established: the physician-led care model works – NOT that unsupervised practice is safe. Further, she argues that this study begs a follow-up question: with such variation in potentially inappropriate prescribing by NPs, what do we know about which NPs were in the top and which were in the bottom?
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