Influence of Primary Care Provider Type on Chronic Pain Management Among Veterans

IF 4.2 4区 医学 Q1 NURSING
Jacqueline Nikpour PhD, RN, Marion Broome PhD, RN, FAAN, Susan Silva PhD, Kelli D. Allen PhD
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引用次数: 1

Abstract

Background

Chronic pain disproportionately impacts veterans and is often treated in primary care, where physician shortages in the Veterans Health Administration (VHA) healthcare system are well documented. Nurse practitioners (NPs) may represent a solution to the care shortage; however, concerns of NP opioid overprescribing have led to NP practice and prescribing restrictions in individual VHA facilities and at the state level. Little is known regarding the prescribing patterns of NPs and physician assistants (PAs) for veterans with chronic pain in the VHA.

Purpose

The purpose of this study was to compare opioid and non-opioid prescribing patterns of physicians, NPs, and PAs for chronic pain patients at VHA centers.

Methods

We used data from the U.S. Department of Veterans Affairs Survey of Healthcare Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Patient medical records for the year were analyzed by provider type (physician, NP, or PA) for differences in providers’ rates of prescribing opioid and non-opioid medications, as well as characteristics of the opioid prescriptions (e.g., high daily morphine milligram equivalent [90 MME/day] dose, long-term opioid therapy [90 days]).

Results

Medical records of a total of 39,936 patients were included. In FY 2016, 55% of patients received one opioid prescription, whereas 83.8% received one non-opioid prescription. Compared to patients of NPs and PAs, patients of physicians had higher odds of receiving opioid (vs. NPs: OR = 1.13, p < 0.01; vs. PAs: OR = 1.16, p < 0.01) and non-opioid prescriptions (vs. NPs: OR = 1.08, p = 0.02; vs. PAs: OR = 1.20, p < 0.01) after adjusting for patient characteristics. There were no differences in high MME/day dose (p = 0.59) or long-term opioid therapy (p = 0.99).

Conclusion

In a national sample of veterans with chronic pain, NPs and PAs did not have higher odds of opioid prescribing. Concerns of NP or PA opioid overprescribing may be addressed by considering evidence that patients of these providers are not at higher odds of receiving an opioid prescription.

Abstract Image

初级保健提供者类型对退伍军人慢性疼痛管理的影响
慢性疼痛对退伍军人的影响尤为严重,通常在初级保健中治疗,而退伍军人健康管理局(VHA)医疗保健系统的医生短缺是有据可查的。执业护士(NPs)可能代表护理短缺的解决方案;然而,对NP阿片类药物过度处方的担忧导致了个体VHA设施和州一级的NP实践和处方限制。关于NPs和医师助理(PAs)在VHA慢性疼痛退伍军人的处方模式知之甚少。目的本研究的目的是比较VHA中心慢性疼痛患者的医生、NPs和PAs的阿片类药物和非阿片类药物处方模式。方法使用2015年10月至2016年9月美国退伍军人事务部患者医疗体验调查和企业数据仓库的数据。按提供者类型(医生、NP或PA)分析该年的患者医疗记录,以了解提供者开具阿片类药物和非阿片类药物处方率的差异,以及阿片类药物处方的特征(例如,每日高吗啡毫克当量[90 MME/天]剂量,长期阿片类药物治疗[90天])。结果共纳入39936例患者的病历。在2016财年,55%的患者接受了一次阿片类药物处方,而83.8%的患者接受了一次非阿片类药物处方。与NPs和PAs患者相比,内科医生患者接受阿片类药物的几率更高(与NPs相比:OR = 1.13, p <0.01;vs. PAs: OR = 1.16, p <0.01)和非阿片类药物处方(相对于NPs: OR = 1.08, p = 0.02;vs. PAs: OR = 1.20, p <0.01)。高MME/天剂量(p = 0.59)和长期阿片类药物治疗(p = 0.99)无差异。结论在全国范围内患有慢性疼痛的退伍军人样本中,NPs和PAs的阿片类药物处方率并不高。通过考虑这些提供者的患者接受阿片类药物处方的可能性并不高的证据,可以解决NP或PA阿片类药物过度处方的问题。
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来源期刊
CiteScore
4.60
自引率
12.50%
发文量
50
审稿时长
54 days
期刊介绍: Journal of Nursing Regulation (JNR), the official journal of the National Council of State Boards of Nursing (NCSBN®), is a quarterly, peer-reviewed, academic and professional journal. It publishes scholarly articles that advance the science of nursing regulation, promote the mission and vision of NCSBN, and enhance communication and collaboration among nurse regulators, educators, practitioners, and the scientific community. The journal supports evidence-based regulation, addresses issues related to patient safety, and highlights current nursing regulatory issues, programs, and projects in both the United States and the international community. In publishing JNR, NCSBN''s goal is to develop and share knowledge related to nursing and other healthcare regulation across continents and to promote a greater awareness of regulatory issues among all nurses.
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