Potentially inappropriate medication prescribing by nurse practitioners and physicians

J Am Geriatr Soc. 2021 Jul;69(7):1916-1924. doi: 10.1111/jgs.17120. Epub 2021 Mar 22.


Background: Potentially inappropriate medication (PIM) use is a risk factor for hospitalization and mortality. However, there were few studies focusing on the impact of provider type on PIM use.

Objective: We aimed to estimate the initial and refill PIM prescribing rate for physician visits and nurse practitioner (NP) visits and the impact of provider type on PIM prescribing.

Research design: We used 100% Texas Medicare data to define physician visits and NP visits in 2016. The rate of visits with a PIM prescription from the same provider was measured, distinguishing between initial and refill prescription to estimate the PIM rate and adjusted odds ratio (OR) by provider type.

Results: There were 24.1 per 1000 visits with a prescription for a PIM: 9.0 per 1000 visits for an initial PIM and 15.1 per 1000 visits for a refill PIM. A visit to an NP was less likely to result in an initial (OR = 0.74, 95% confidence interval [CI] = 0.70-0.79) or refill (OR = 0.54, 95% CI = 0.51-0.57) PIM. The association of lower odds of receiving a prescription for an initial PIM from an NP was substantially stronger among black enrollees than white enrollees (OR = 0.44, 95%CI = 0.30-0.65 for blacks and OR = 0.73, 95%CI = 0.68-0.78 for white enrollees). The association of an NP provider with lower odds of receiving a PIM refill was more pronounced in older patients and in those with more comorbidities.

Conclusions: NPs prescribed fewer initial PIMs and were less likely to refill a PIM after an outpatient visit than physicians. The lower odds of receiving PIMs during an NP visit varied by age, race/ethnicity, rurality, and number of comorbidities.

Keywords: nurse practitioners; potentially inappropriate medication; quality of prescribing.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care / statistics & numerical data*
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Inappropriate Prescribing / statistics & numerical data*
  • Male
  • Medicare
  • Nurse Practitioners / statistics & numerical data*
  • Odds Ratio
  • Physicians / statistics & numerical data*
  • Risk Factors
  • Texas
  • United States