美国全国范围内的研究：州级护士从业规范对医师和执业护士之间潜在不适当药物处方的影响。
Impact of State Nurse Practitioner Regulations on Potentially Inappropriate Medication Prescribing Between Physicians and Nurse Practitioners: A National Study in the United States.
机构信息
School of Nursing (Dr Tzeng), Department of Internal Medicine (Drs Raji and Kuo), Sealy Center on Aging (Drs Tzeng, Raji, and Kuo), Department of Preventive Medicine and Population Health (Dr Kuo), and Office of Biostatistics (Ms Chou and Dr Kuo), University of Texas Medical Branch, Galveston.
出版信息
J Nurs Care Qual. 2022;37(1):6-13. doi: 10.1097/NCQ.0000000000000595.
BACKGROUND
The American Geriatrics Society regularly updates the Beers Criteria for Potentially Inappropriate Medication (PIM) to improve prescribing safety.
PURPOSE
This study assessed the impact of nurse practitioner (NP) practices on PIM prescribing across states in the United States and compared the change in PIM prescribing rates between 2016 and 2018.
METHODS
We used data from a random selection of 20% of Medicare beneficiaries (66 years or older) from 2015 to 2018 to perform multilevel logistic regression. A PIM prescription was classified as initial or refill on the basis of medication history 1 year before a visit. PIM use after an outpatient visit was the primary study outcome.
RESULTS
We included 9 000 224 visits in 2016 and 9 310 261 in 2018. The PIM prescription rate was lower in states with full NP practice and lower among NPs than among physicians; these rates for both physicians and NPs decreased from 2016 to 2018.
CONCLUSIONS
Changes could be due to individual state practices.
背景
美国老年医学会定期更新潜在不适当药物（PIM）的 Beers 标准，以提高处方安全性。
目的
本研究评估了美国各州执业护士（NP）实践对 PIM 处方的影响，并比较了 2016 年至 2018 年 PIM 处方率的变化。
方法
我们使用了 2015 年至 2018 年随机选择的 20% Medicare 受益人的数据（66 岁或以上）进行了多层次逻辑回归分析。根据就诊前一年的用药史，将 PIM 处方分类为初始处方或续方。门诊就诊后使用 PIM 是主要的研究结果。
结果
我们纳入了 2016 年的 9000224 次就诊和 2018 年的 9310261 次就诊。在完全允许 NP 执业的州，PIM 处方率较低，NP 开具 PIM 的比例低于医生；2016 年至 2018 年，医生和 NP 的这一比例均有所下降。
结论
这些变化可能是由于各州的具体实践情况不同。
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