University of Alabama School of Law.
Milbank Q. 2021 Sep;99(3):721-745. doi: 10.1111/1468-0009.12524. Epub 2021 Jun 29.
Policy Points The increased use of nurse practitioners represents a viable policy option to address continuing access-to-care deficiencies across the United States, but state scope-of-practice laws limit the ability of nurse practitioners to deliver health care. Groups in favor of restrictive scope-of-practice laws have argued that relaxing these laws will lead to increases in opioid prescriptions during an already severe opioid crisis, implicating patient safety concerns. An examination of a data set of 1.5 billion opioid prescriptions demonstrates that relaxing nurse practitioner scope-of-practice laws generally reduces opioid prescriptions. This evidence supports eliminating restrictive scope-of-practice laws that currently govern nurse practitioners in many states.
As many parts of the United States continue to face physician shortages, the increased use of nurse practitioners (NPs) can improve access to care. However, state scope-of-practice (SOP) laws limit the ability of NPs to provide care by restricting the services they can provide and often requiring physician supervision of their practices. One important justification for the continuation of these restrictive SOP laws is preventing the overprescription of certain medications, particularly opioids.
This study examined a data set of approximately 1.5 billion individual opioid prescriptions between 2011 and 2018, which were aggregated to the individual provider-year level. A series of difference-in-differences regression models was estimated to examine the association between laws allowing NPs to practice independently and opioid prescribing patterns among physicians and NPs. Opioid prescriptions were measured in total annual morphine milligram equivalents (MMEs) prescribed by individual providers.
Across all NPs and physicians, independent NP practice was associated with a statistically significant decline of 6%, 2%, 3%, 7%, and 5% in total annual MMEs prescribed to commercially insured, cash-paying, Medicare, government-assistance, and all patients, respectively. Medicaid patients saw no statistically significant change in annual MMEs. Across all payers, NPs generally increase and physicians generally decrease the number of opioids they prescribe following a grant of NP independence. These counterbalancing changes result in an overall net decline in MMEs.
No evidence supports the contention that allowing NPs to practice independently increases opioid prescriptions. The results support policy changes that allow NPs to practice independently.
政策要点 增加执业护士的使用代表了一种可行的政策选择，可以解决美国各地持续存在的医疗服务可及性不足的问题，但州级执业范围法律限制了执业护士提供医疗保健的能力。支持限制执业范围法律的团体认为，放宽这些法律将导致在已经严重的阿片类药物危机期间增加阿片类药物处方，这涉及到患者安全问题。对 15 亿份阿片类药物处方数据集的审查表明，放宽执业护士执业范围法律通常会减少阿片类药物处方。这一证据支持取消目前许多州对执业护士实施的限制性执业范围法律。
随着美国许多地区继续面临医生短缺的问题，增加执业护士（NP）的使用可以改善医疗服务的可及性。然而，州级执业范围（SOP）法律限制了 NP 提供护理的能力，限制了他们提供的服务，并且通常要求医生监督他们的实践。继续实施这些限制性 SOP 法律的一个重要理由是防止某些药物，特别是阿片类药物的过度处方。
本研究审查了 2011 年至 2018 年间约 15 亿份个体阿片类药物处方的数据集，这些数据汇总到个体提供者-年水平。使用一系列差分差异回归模型来评估允许 NP 独立执业的法律与医生和 NP 之间的阿片类药物处方模式之间的关联。阿片类药物处方以个体提供者开具的总年度吗啡毫克当量（MME）为衡量标准。
在所有 NP 和医生中，NP 独立执业与商业保险、现金支付、医疗保险、政府援助和所有患者的总年度 MME 处方分别下降了 6%、2%、3%、7%和 5%，具有统计学意义。医疗补助患者的年度 MME 无统计学显著变化。在所有支付者中，NP 通常会增加，医生通常会减少他们开具的阿片类药物数量，这是在给予 NP 独立性之后。这些相互抵消的变化导致 MME 总量下降。
没有证据支持允许 NP 独立执业会增加阿片类药物处方的观点。结果支持允许 NP 独立执业的政策变化。
