Scope-of-Practice for Nurse Practitioners and Adherence to Medications for Chronic Illness in Primary Care

Ulrike Muench; Christopher Whaley; Janet Coffman; Joanne Spetz

doi:10.1007/s11606-020-05963-3

Scope-of-Practice for Nurse Practitioners and Adherence to Medications for Chronic Illness in Primary Care

J Gen Intern Med. 2021 Feb;36(2):478-486. doi: 10.1007/s11606-020-05963-3. Epub 2020 Jun 24.

Authors

Ulrike Muench^{1

2}, Christopher Whaley³, Janet Coffman⁴, Joanne Spetz⁴

Affiliations

¹ Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA, USA. Ulrike.muench@ucsf.edu.
² Philip R. Lee Institute for Health Policy Studies, Department of Community and Family Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA. Ulrike.muench@ucsf.edu.
³ RAND Corporation and School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
⁴ Philip R. Lee Institute for Health Policy Studies, Department of Community and Family Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.

Abstract

Background: Nonadherence to medications is costly and improving adherence is difficult, requiring multifactorial solutions, including policy solutions.

Objective: The purpose of this study is to evaluate the effect of one policy strategy on medication adherence. Specifically, we examine the effect on adherence of expanding scope-of-practice regulations for nurse practitioners (NPs) to practice and prescribe without physician supervision.

Design: We conducted three difference-in-difference multivariable analyses of commercial insurance claims.

Participants: Patients who filled at least two prescriptions in one of three chronic therapeutic medications: anti-diabetics (n = 514,255), renin angiotensin system antagonists (RASA) (n = 1,679,957), and anti-lipidemics (n = 1,613,692).

Main measures: Medication adherence was measured as the proportion of days covered (PDC). We used one continuous (PDC 0-1) and one binary outcome (PDC of > .8), the latter indicating good adherence.

Key results: Patients taking anti-diabetic medications had a 1.9 percentage point higher medication adherence rate (p < 0.05) and a 2.7 percentage point higher probability of good adherence (p < 0.001) in states that expanded NP scope-of-practice. Medication adherence for patients taking RASA was higher by 2.3 percentage points (p < 0.001) and 3.4 percentage points (p < 0.01) for both measures, respectively. Patients taking anti-lipidemics saw a smaller, but statistically insignificant, improvement in adherence.

Conclusions: Results indicate that scope-of-practice regulations that allow NPs to practice and prescribe without physician oversight are associated with improved medication adherence. We postulate that the mechanism for this effect is increased access to health care services, which in turn increases access to prescriptions. Our results suggest that policies allowing NPs to maximally use their skills can be beneficial to patients.

Keywords: administrative claims data; medication adherence; nurse practitioners; policy evaluation; scope-of-practice.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Chronic Disease
Humans
Hypoglycemic Agents / therapeutic use
Medication Adherence*
Nurse Practitioners*
Primary Health Care
United States

Substances

Hypoglycemic Agents

Grants and funding

K01 AG061274/AG/NIA NIH HHS/United States