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Stephanie Goldberg

Nurse practitioners, physician assistants prescribe more opioids: Study

April 28, 2014 - 5:27pm

Opioid Prescriptions 2014


Nurse practitioners and physician assistants wrote more opioid prescriptions for injured workers in 2013, concluded an analysis released Monday.

The “2014 Drug Trend Report” was based on more than 300,000 claims and more than 6 million prescriptions in 2013. The data combined results of the pharmacy programs of Westerville, Ohio-based Progressive Medical Inc. and Tampa, Fla.-based PMSI Inc., which merged in October.

Nurse practitioners and physician assistants, according to the report, wrote 15.8% of prescriptions for opioid medications for injured workers in 2013, with nurse practitioners writing 6.6% and physician assistants writing 9.2%. That compares with an IMS Health study that found nurse practitioners and physician assistants each wrote about 6.5% of prescriptions for opioids outside of workers comp in the same year.

Claims for such prescriptions written by nurse practitioners have an 8% higher long-term pharmacy cost than those written by other medical professionals, according to the analysis. It did not measure physician assistants' long-term pharmacy costs.

Dr. Robert Hall, medical director of Progressive and PMSI, said the trend likely has to do with accessibility.

“Once physicians reach a level of capacity and can no longer bring in additional patients, they'll hire midlevel practitioners to help take care of maintaining the prescribing for their patients who are stabilized so they can open up additional time slots in their schedules for new patients,” Mr. Hall said. “It improves the accessibility for patients and injured workers to see their providers more frequently.”

Increased accessibility

The reason claims with prescriptions written by nurse practitioners had an 8% higher long-term pharmacy cost than those by other prescribers also could come down to an increase in face-to-face meetings with providers, Dr. Hall said.

“With increased accessibility, patients are going to get to see their nurse practitioner or their physician assistant more frequently, and there might be a higher opportunity for medication changes or dosing changes,” Dr. Hall said.

Other findings include a 1.7% decrease in prescription cost per claim, a 5% decrease in the utilization of opioid medications and a 9.6% decrease per claim in the morphine equivalency dose — which is used to measure dosages of opioid medications — in 2013 compared with 2012.

The use of compounded medications represented 0.69% of the total number of prescriptions written for injured workers in 2013, up from 2012's 0.62%, according to the analysis.

In a report released last week, the companies said clinical interventions reduced chronic opioid use by 32% over the course of one year among more than 100 at-risk injured workers.

 



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