Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Pain Med. 2020 Jan 1;21(1):76-83. doi: 10.1093/pm/pnz005.
To determine if there are differences in opioid prescribing among generalist physicians, nurse practitioners (NPs), and physician assistants (PAs) to Medicare Part D beneficiaries.
Serial cross-sectional analysis of prescription claims from 2013 to 2016 using publicly available data from the Centers for Medicare and Medicaid Services.
All generalist physicians, NPs, and PAs who provided more than 10 total prescription claims between 2013 and 2016 were included. These prescribers were subsetted as practicing in a primary care, urgent care, or hospital-based setting.
The main outcomes were total opioid claims and opioid claims as a proportion of all claims in patients treated by these prescribers in each of the three settings of interest. Binomial regression was used to generate marginal estimates to allow comparison of the volume of claims by these prescribers with adjustment for practice setting, gender, years of practice, median income of the ZIP code, state fixed effects, and relevant interaction terms.
There were 36,999 generalist clinicians (physicians, NPs, and PAs) with at least one year of Part D prescription drug claims data between 2013 and 2016. The number of adjusted total opioid claims across these four years for physicians was 660 (95% confidence interval [CI] = 660-661), for NPs was 755 (95% CI = 753-757), and for PAs was 812 (95% CI = 811-814).
We find relatively high rates of opioid prescribing among NPs and PAs, especially at the upper margins. This suggests that well-designed interventions to improve the safety of NP and PA opioid prescribing, along with that of their physician colleagues, could be especially beneficial.
确定在向医疗保险 D 部分受益人开具阿片类药物处方方面，全科医生、护士从业者 (NPs) 和医师助理 (PAs) 之间是否存在差异。
使用医疗保险和医疗补助服务中心提供的公开数据，对 2013 年至 2016 年的处方索赔进行连续横断面分析。
所有在 2013 年至 2016 年期间提供超过 10 份总处方的全科医生、NPs 和 PAs 均包括在内。这些开处方者被细分为在初级保健、紧急护理或医院环境中执业。
主要结果是这些开处方者在三个感兴趣的环境中治疗的患者的总阿片类药物索赔和阿片类药物索赔占所有索赔的比例。使用二项式回归生成边际估计值，以便在调整实践环境、性别、执业年限、邮政编码中位数收入、州固定效应和相关交互项后，比较这些开处方者的索赔量。
在 2013 年至 2016 年期间，至少有一年医疗保险 D 部分药物处方数据的全科医生 (医生、NPs 和 PAs) 有 36,999 名。这四年中，医生的调整后总阿片类药物索赔数为 660（95%置信区间 [CI] = 660-661），NPs 为 755（95% CI = 753-757），PA 为 812（95% CI = 811-814）。
我们发现 NPs 和 PAs 开具阿片类药物的比率相对较高，尤其是在上限。这表明，精心设计的干预措施可以提高 NP 和 PA 阿片类药物处方的安全性，同时也提高他们的医生同事的安全性，这可能特别有益。
