Physician Assistants

In an effort to identify which health care providers may be over prescribing opioids and potentially fueling the opioid epidemic, Johns Hopkins researchers looked at the different type of providers at the front lines of caring for patients—general practitioners.
The educational curriculum for nurses is designed to prepare them to work in any health-care setting. A licensed practical nurse, or LPN, typically completes a one-year training program to earn a nursing certificate and work in a generalist job. A registered nurse, or RN, has either an associate’s degree or a bachelor of science in nursing.

Assigned to permanent duties

New LPNs might be assigned to permanent duties immediately; but most new RN hires in hospitals or clinics do rotations in different departments to learn the ropes. Only after at least a few months of experience do RNs start to choose specialties; must have at least one year of experience as a generalist before applying to a specialty or advanced practice nurse training program.

Nurses may pursue one of many specialties, including critical care; also cardiovascular health, pediatrics or addiction. Some nurses develop overlapping specialties; such as pediatric critical care or pediatric oncology nurses. Accredited nursing schools offer a wide variety of nurse specialist training programs; also most require six months to one year to complete. You must also pass an exam to qualify for a certificate.

The researchers found that among general practitioners in a primary care; so urgent care or hospital setting, physician assistants (PAs) prescribed the most opioids, follow by nurse practitioners (NPs) and then physicians. The researchers say their findings, published online on March 1 in Pain Medicine; so suggest that physician assistants and nurse practitioners may need more education and better oversight to prevent overprescribing.

Prescription database of older

Using data from Medicare’s publicly available Part D prescription database of older Americans from 2013-2016; so the researchers identified 36,999 general practitioners including physicians; hence nurse practitioners and physician assistants who prescribed more than 10 prescriptions; so over a year-long period in a primary care, urgent care or hospital setting.
Of the generalist prescribers among the highest 5% of opioid prescription rates; so 43% are PAs even though PAs only make 12% of all general practitioners. PAs practicing in an urgent care setting prescribe opioids at the highest rate of all groups in all settings ¾ nearly 12% of their prescriptions were for opioids compared to 6.7% for physicians and 4.8% for NPs. In hospitals, physician assistants wrote 11% of their prescriptions for opioids, compared to 8.1% for nurse practitioners and 6.7% for physicians.
It’s possible that the numbers come out this way due to different roles that PAs and NPs have in each setting, or it could be a result of drug reps marketing directly to this kind of health care provider, which could lead to higher prescribing rates,” says Michael Ellenbogen, M.D., assistant professor of medicine at the Johns Hopkins University School of Medicine. “In fact, evidence from recent lawsuits against Purdue Pharmaceuticals suggests this may be the case.”