Physician assistant and nurse practitioner prescribing: 1997-2002.
BACKGROUND
Physician assistants (PAs) and nurse practitioners (NPs) have licensure to practice in all states and they have prescriptive authority in 47 and 40 states, respectively. However, there have been no published studies from a national standpoint comparing urban and rural settings.


OBJECTIVE
The objective of this study was to describe the characteristics of providers, patients, and the type of prescriptions written by PAs and NPs and to compare these activities to those of physicians in metropolitan and nonmetropolitan settings.


METHODS
The National Ambulatory Medical Care Survey was used to analyze a representative sample of 149,202 visits to primary care physician offices over a 6-year period (1997-2002) in which a prescription was written by a PA, NP or physician.


RESULTS
A PA or NP was the provider of record for 3% of the primary care visits. The 3 providers wrote prescriptions for 60% to 70% of all visits, and the mean number of prescriptions was 1.3 to 1.5 per visit (range 0-5), depending on the provider. PAs were more likely to prescribe a controlled substance than were physicians or NPs (19.5%, 12.4%, 10.9% respectively). Only in rural areas did differences emerge. In rural areas, NPs wrote significantly more prescriptions than physicians and PAs, and PAs wrote significantly fewer prescriptions than the other providers.


CONCLUSIONS
Overall, PAs and NPs are prescribing in a manner similar to physicians in the type of medications used in their patient management. In nonmetropolitan areas, prescribing differences among the 3 types of providers bear further exploration.
Hooker
Roderick S
RS
Department of Veterans Affairs, Medical Service (111), 4500 S. Lancaster Road, Dallas, TX 75216-7191, USA. roderick.hooker@med.va.gov
Cipher
Daisha J
DJ
D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D000704:Analysis of Variance; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D019538:Health Care Surveys; D006801:Humans; D009722:Nurse Practitioners / Q000592:standards / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data; D010823:Physician Assistants / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards* / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D014481:United States; D019037:Urban Health Services / Q000592:standards* / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data