Abstract
Purpose
To describe opioid prescribing practice patterns and trends in emergency department
visits (EDs) by provider type: physicians and advanced practice providers (APPs),
which include nurse practitioners (NPs) and physician assistants (PAs).
Methods
The data source was the ED visit files of the 2005–2015 National Hospital Ambulatory
Care Survey. The study sample was opioid prescription-related ED visits. Descriptive
and multinomial logistic regression analyses were conducted to assess the proportion
of opioid prescription-related visits by provider type over time in total and by patient
age group. We then characterized opioid prescribing practices of NPs, PAs, and physicians
according to type of opioid and pain-related diagnosis.
Results
From 2005 to 2015, there was a 116.7% increase in the proportion of the opioid prescription-related
visits seen by NPs and a 61.2% increase seen by both APPs and physicians. In contrast,
the proportion of the physician-only visits decreased (−8.3%). When stratified by
age group, the growth was particularly notable among the visits with patients aged
65 and older seen by both APPs and physicians (AOR = 2.35, 95% CI = 1.69, 3.25). Proportionally
less hydromorphone and morphine was prescribed by APPs than by physicians. Opioids
were prescribed more often by APPs in visits involving dental and injury-related pain,
whereas physicians prescribed opioids more in abdominal and chest pain-related visits.
Conclusions
From 2005 to 2015, APPs, particularly NPs played an increasing role in opioid prescribing
in EDs. Opioid prescribing practices of APPs and physicians varied by patient condition
as well as by opioid type.
Keywords
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Article Info
Publication History
Published online: October 22, 2018
Accepted:
October 19,
2018
Received:
September 3,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
