Recent Study Finds APCs Write Quarter of Opioid Refills

Sarasota, FL (WorkersCompensation.com) – Advanced practice clinicians (APC) includes physician assistants (PAs), Nurse Practitioners (NPs), and registered nurses. In many cases, APCs allow physicians to have a tighter focus in treating patients. Some of the benefits for utilizing APCs in medical practices include access to care, improvement of outcomes, increased productivity, and reduction of cost. 

According to data from the Bureau Of Labor Statistics, the number of employed Physician Assistants is expected to increase by 28 percent by 2031. By comparison, the number of jobs for Nurse Practitioners is projected to increase by 40 percent during the same period. 

While physicians have utilized APCs to maximize their ability to see patients, the relationship has been somewhat contentious the last couple of years as proposed legislation offered to increase the privileges of APCs. A recent study published in JAMA Network Open suggests that the support role of APCs may need scrutiny. 

Researchers from the University of Michigan Medical School in Ann Arbor, Michigan analyzed what portion of opioid prescriptions were written by APCs as opposed to surgeons for patients that had undergone surgical procedures. The team reviewed medical records on patients that underwent one of 31 surgical procedures from 2017 to 2019. Patients utilized in the study had received at least one opioid prescription within 3 days of the surgery. Total dosage was measured in morphine milligram equivalents (MMEs), and compared between provider type. 

A total of 628,197 procedures for 581,387 patients were used for the study. Orthopedic procedures accounted for 39.6 percent of the total procedures, and general surgery accounted for 29.2 percent. The top volume procedure was total knee arthroplasty, followed by inguinal femoral hernia repair, and cholecystectomy.

Overall, the APCs wrote 19 percent of the prescriptions, compared to 73.1 percent written by the surgeons, and 7.9 percent written by other prescribers. In the APC category, Physician Assistants wrote the majority of prescriptions at 14.1 percent, compared to 4.9 percent for Nurse Practitioners. Other prescribers included internists who wrote 42.7 percent of prescriptions for their category, and family medicine physicians who wrote 14.8 percent of the prescriptions. 

Of the total procedures, 25.1 percent had one or more refills, with a total of 237,740 refill prescriptions. Of those refills, 52.5 percent was written by the surgeon, 25.1 percent by the APCs, and 22.4 percent by other prescribers. 

One trend noted in the study was that the number of prescriptions was higher for APCs for older patients, and those living in the Northeast. Thoracic surgery, neurosurgery, and transplant surgery were the highest specialties for APC prescriptions. 

Overall, the researchers determined that one-fifth of the opioid prescriptions, and a quarter of the refills after surgery were written by APCs. Additionally, the total dosages were higher for the APCs than the surgeon group. The researchers believe the study results support the need for future studies reviewing quality improvement initiates that support APC opioid prescribing. 

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