Assessment of Prescription Patterns of Nurse Practitioners in Emergency Departments

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Research Objective: Nurse practitioners (NPs) play an important role in the delivery of healthcare and are often instrumental in the delivery of primary care. Changes in state laws and reimbursement have expanded the practice scope of NPs over time. While a number of studies have focused on the overall practice patterns of NPs, not much is known about their prescribing behavior, in comparison to physicians. The purpose of this study is to comparatively assess the prescribing practices of physicians and NPs, in terms of number of medications prescribed in the Emergency Department (ED).

Study Design: A retrospective, observational study was conducted using data from the National Hospital Ambulatory Medical Care Survey (ED Component) on a sample of persons presenting to the ED between 2009 and 2011. A negative binomial regression model was used to examine the association between number of medications prescribed in the ER and provider type, in a pooled cross-sectional design. Patient characteristics included in the model were gender, race/ethnicity, age, immediacy of condition, payer source, day and time of visit. Hospital level characteristics assessed included ownership type, region and rurality. Statistical analyses were weighted appropriately to obtain nationally representative estimates.

Population Studied: Patients 18 years and older presenting to the ED between 2009 and 2011. We eliminated observations for whom there were no information on provider type (8,262). The weighted total number of visits for the study was 263,098,523.

Principal Findings: NPs, compared to physicians, prescribed 16 percent less medications for patients they saw at the ED (p=0.009). Compared to privately insured patients Medicare and uninsured patients were prescribed with less medications (10 percent less, p=0.006 & 46.7 percent less, p=0.023, respectively). Older patients received more medications (p=), while patients presenting to hospitals in the Midwest (p=), South (p=) and West (p=) were prescribed more medication compared to those in the North. ED visits during the day results in less prescribed medications than at night (p<0.001). Additionally, an increasing temporal trend in the number of medications prescribed at the ED was observed over the study period.

Conclusions: Prescribing behavior in the ED was found to differ by type of provider, even after adjusting for the immediacy of the patient’s condition.

Implications for Policy or Practice: Additional research is needed to assess the implications of prescribing behavior to the quality of care delivered to patients.


Academy Health Annual Research Meeting (ARM)


Boston, MA