Impact of Maryland's 2015 Nurse Practitioner Full Scope of Practice Law on Statewide Rates of Outpatient Potentially Harmful Medication Prescribing to Older Adults.

Abstract

Background: Since 2010, there has been an increase in Full Scope of Practice (FSP) laws allowing nurse practitioners (NPs) to practice independently. We aimed to utilize synthetic control models to examine the impact of a 2015 NP FSP laws on outpatient potentially harmful medication (PHM) prescribing to older adults (65 years and above) in Maryland.

Methods: We utilized Medicare Public Use Files to measure statewide rates of outpatient PHM prescribing to older adults with Part D from fiscal year 2013-2019. An interrupted time series analysis was performed, and geographic and health access covariates were used to create synthetic control models. Placebo tests were used to test differences in PHM prescribing after the policy change.

Results: The interrupted time series analysis was not significant. Maryland's synthetic control model chose a weighted average of New Jersey, Delaware, and Massachusetts. There was no significant difference in PHM prescribing after the passage of Maryland's FSP law compared with synthetic control.

Discussion: We found that Maryland's FSP law did not impact statewide rates of PHM prescribing. State-wide prescribing trends should be considered in states debating changes in nurse practitioner scope of practice.