{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T05:30:23Z","timestamp":1791955823070,"version":"4.3.4"},"reference-count":48,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,3,26]],"date-time":"2018-03-26T00:00:00Z","timestamp":1522022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Nurse practitioners (NPs) and physician assistants (PAs) have increasingly broad prescribing authority in the United States, yet little is known regarding how the quality of their prescribing practices compares with that of physicians. The objective of this study was to compare the quality of prescribing practices of physicians and nonphysician providers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A serial cross\u2010sectional analysis of the 2006\u20132012 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey was performed. Ambulatory care services in physician offices, hospital emergency departments, and outpatient departments were evaluated using a nationally representative sample of patient visits to physicians, NPs, and PAs. Main outcome measures were 13 validated outpatient quality indicators focused on pharmacologic management of chronic diseases and appropriate medication use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 701,499 sampled patient visits were included during the study period, representing ~8.33 billion visits nationwide. Physicians were the primary provider for 96.8% of all outpatient visits examined; NPs and PAs each accounted for 1.6% of these visits. The proportion of eligible visits where quality standards were met ranged from 34.1% (angiotensin\u2010converting enzyme inhibitor use for congestive heart failure) to 89.5% (avoidance of inappropriate medications among elderly). The median overall performance across all indicators was 58.7%. On unadjusted analyses, differences in quality of care between nonphysicians and physicians for each indicator did not consistently favor one practitioner type over others. After adjustment for potentially confounding patient and provider characteristics, the quality of prescribing by NPs and PAs was similar to the care delivered by physicians for 10 of the 13 indicators evaluated, and no consistent directional association was found between provider type and indicator fulfillment for the remaining measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although significant shortfalls exist in the quality of ambulatory prescribing across all practitioner types, the quality of care delivered by nonphysicians and physicians was generally comparable.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2095","type":"journal-article","created":{"date-parts":[[2018,2,21]],"date-time":"2018-02-21T11:37:41Z","timestamp":1519213061000},"page":"417-427","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Quality of Prescribing by Physicians, Nurse Practitioners, and Physician Assistants in the United States"],"prefix":"10.1002","volume":"38","author":[{"given":"Shiyin","family":"Jiao","sequence":"first","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland"},{"name":"Center for Drug Safety and Effectiveness Johns Hopkins University Baltimore Maryland"},{"name":"Department of Public Health Sciences University of Chicago Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8442-4286","authenticated-orcid":false,"given":"Irene B.","family":"Murimi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland"},{"name":"Center for Drug Safety and Effectiveness Johns Hopkins University Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall S.","family":"Stafford","sequence":"additional","affiliation":[{"name":"Program on Prevention Outcomes and Practices Stanford Prevention Research Center Stanford University School of Medicine Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramin","family":"Mojtabai","sequence":"additional","affiliation":[{"name":"Center for Drug Safety and Effectiveness Johns Hopkins University Baltimore Maryland"},{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland"},{"name":"Department of Psychiatry Johns Hopkins Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Caleb","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland"},{"name":"Center for Drug Safety and Effectiveness Johns Hopkins University Baltimore Maryland"},{"name":"Division of General Internal Medicine Department of Medicine Johns Hopkins Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,26]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-141-9-200411020-00012"},{"key":"e_1_2_6_3_1","unstructured":"U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professions.Physician supply and demand: projections to 2020 2006. Available fromhttps:\/\/bhw.hrsa.gov\/sites\/default\/files\/bhw\/nchwa\/projections\/physician2020projections.pdf. Accessed May 10 2016."},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2011.03.005"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.0714"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1745-7599.2006.00133.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558714563763"},{"key":"e_1_2_6_8_1","unstructured":"Drug Enforcement Administration.Mid\u2010level practitioners authorization by state. Available fromhttp:\/\/www.deadiversion.usdoj.gov\/drugreg\/practioners\/mlp_by_state.pdf. Accessed April 19 2016."},{"key":"e_1_2_6_9_1","unstructured":"American Association of Physician Assistants.Florida passes historic PA prescribing legislation 2016. Available fromhttps:\/\/www.aapa.org\/twocolumn.aspx?id=2147487244. Accessed July 27 2016."},{"key":"e_1_2_6_10_1","unstructured":"Barton Associates.PA scope of practice laws 2016. Available fromhttps:\/\/www.bartonassociates.com\/interactive-tools\/pa-scope-of-practice-laws\/. Accessed January 13 2017."},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-6723.2010.01368.x"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13662"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-143-10-200511150-00010"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(99)00180-7"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nurpra.2013.07.004"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000590"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2013.12.003"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12960-015-0049-8"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000128005.27364.72"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1150"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.032177"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-140-9-200405040-00011"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13654"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.1.59"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478-4491-10-42"},{"key":"e_1_2_6_26_1","unstructured":"NAMCS\/NHAMCS.Ambulatory health care data. Available fromhttp:\/\/www.cdc.gov\/nchs\/ahcd.htm. Accessed September 25 2015."},{"key":"e_1_2_6_27_1","unstructured":"Cerner Multum. Lexicon Plus. Available fromhttp:\/\/www.multum.com\/lexicon.html. Accessed March 10 2016."},{"key":"e_1_2_6_28_1","unstructured":"2011 NAMCS micro\u2010data file documentation. Available fromftp:\/\/ftp.cdc.gov\/pub\/Health_Statistics\/NCHS\/Dataset_Documentation\/NAMCS\/doc2011.pdf. Accessed March 10 2016."},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1997.00440350031003"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.22.2823"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558704266821"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558709346277"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.12.1354"},{"key":"e_1_2_6_34_1","unstructured":"Agency for Healthcare Research and Quality.The number of nurse practitioners and physician assistants practicing primary care in the United States. Primary Care Workforce Facts and Stats No. 2. 2014. Available fromhttp:\/\/www.ahrq.gov\/research\/findings\/factsheets\/primary\/pcwork2\/index.html. Accessed July 29 2016."},{"issue":"11","key":"e_1_2_6_35_1","article-title":"Unequal distribution of the U.S. primary care workforce","volume":"87","author":"Petterson SM","year":"2013","journal-title":"Am Fam Physician"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.282170"},{"key":"e_1_2_6_37_1","unstructured":"American Association of Nurse Practitioners.Ask your members of Congress to cosponsor S. 2279\/H.R. 4134. Available fromhttps:\/\/www.aanp.org\/legislation-regulation\/advocacy-center. Accessed July 29 2016."},{"key":"e_1_2_6_38_1","unstructured":"American Association of Nurse Practitioners.Support NPs ability to prescribe medication\u2010assisted therapies MATs. Available fromhttps:\/\/www.aanp.org\/legislation-regulation\/advocacy-center. Accessed July 29 2016."},{"key":"e_1_2_6_39_1","unstructured":"American Association of Physician Assistants.AAPA letter of support for Sen Udall BUP study 03282014 2014. Available fromhttps:\/\/www.aapa.org\/workarea\/downloadasset.aspx?id=2252. Accessed July 29 2016."},{"key":"e_1_2_6_40_1","unstructured":"American Association of Physician Assistants.Hawaii PAs obtain full prescriptive authority 2015. Available fromhttps:\/\/www.aapa.org\/twocolumn.aspx?id=2147485236. Accessed July 29 2016."},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/2327-6924.12293"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2014.08.008"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2014.09.033"},{"key":"e_1_2_6_44_1","unstructured":"ParadiseJ DarkC BitlerN.Improving access to adult primary care in Medicaid: exploring the potential role of nurse practitioners and physician assistants. 2011. Available fromhttps:\/\/kaiserfamilyfoundation.files.wordpress.com\/2013\/01\/8167.pdf. Accessed July 30 2016."},{"key":"e_1_2_6_45_1","unstructured":"GinsburgJ TaylorT BarrMS.Nurse practitioners in primary care.2009. Available fromhttps:\/\/www.acponline.org\/system\/files\/documents\/advocacy\/current_policy_papers\/assets\/np_pc.pdf. Accessed April 22 2016."},{"issue":"2","key":"e_1_2_6_46_1","first-page":"74","article-title":"NPs, shorter training needed to fix workforce shortage in primary care","volume":"89","author":"Volpintesta E","year":"2014","journal-title":"Am Fam Physician"},{"issue":"11","key":"e_1_2_6_47_1","first-page":"756","article-title":"Osteopathic schools are producing more graduates, but fewer are practicing in primary care","volume":"91","author":"Barnes K","year":"2015","journal-title":"Am Fam Physician"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000223460.60033.79"},{"key":"e_1_2_6_49_1","unstructured":"National ambulatory medical care survey: 2012 state and national summary tables. Available fromhttps:\/\/www.cdc.gov\/nchs\/data\/ahcd\/namcs_summary\/2012_namcs_web_tables.pdf. Accessed January 4 2018."}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fphar.2095","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.2095","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T09:54:26Z","timestamp":1761040466000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.2095"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,26]]},"references-count":48,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1002\/phar.2095"],"URL":"https:\/\/doi.org\/10.1002\/phar.2095","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,26]]},"assertion":[{"value":"2018-03-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}