Prescribing patterns of gerontological nurse practitioners in the United States

Abstract Background: Widespread inappropriate antibiotic prescribing is a major driver of resistance. Little is known about antifungal prescribing practices in the United States, which is concerning given emerging resistance in fungi, particularly to azole antifungal agents. Objective: We analyzed outpatient antifungal prescribing data in the United States to inform stewardship efforts. Design: Descriptive analysis of outpatient antifungal prescriptions dispensed during 2018 in the IQVIA Xponent database. Methods: Prescriptions were summarized by drug, sex, age, geography, and healthcare provider specialty. Census denominators were used to calculate prescribing rates among demographic groups. Results: Healthcare providers prescribed 22.4 million antifungal courses in 2018 (68 prescriptions per 1,000 persons). Fluconazole was the most commonly prescribed drug (75%), followed by terbinafine (11%) and nystatin (10%). Prescription rates were higher among females versus males (110 vs 25 per 1,000 population) and adults versus children (82 vs 27 per 1,000 population). Prescription rates were highest in the South (81 per 1,000 population) and lowest in the West (48 per 1,000 population). Nurse practitioners and family practitioners prescribed the most antifungals (43% of all prescriptions), but the highest prescribing rates were among obstetrician-gynecologists (84 per provider). Conclusions: Prescribing antifungal drugs in the outpatient setting is common, with enough courses dispensed for 1 in every 15 US residents in 2018. Fluconazole use patterns suggest vulvovaginal candidiasis as a common indication. Regional prescribing differences could reflect inappropriate use or variations in disease burden. Further study of higher antifungal use in the South could help target antifungal stewardship practices.

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Pediatric Nurse Practitioners in the United States: Current Distribution and Recent Trends in Training

Yearbook of Pediatrics ◽

10.1016/j.yped.2011.04.002 ◽

2012 ◽

Vol 2012 ◽

pp. 311-313

Author(s):

J.A. Stockman

Keyword(s):

United States ◽

Nurse Practitioners ◽

Current Distribution ◽

The United States ◽

Pediatric Nurse ◽

Recent Trends ◽

Pediatric Nurse Practitioners

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1428. Lyme Disease Treatment in the United States: Prescribing Patterns from a Nationwide Commercial Insurance Database, 2016-2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1610 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S720-S720

Author(s):

Amy M Beeson ◽

Grace E Marx ◽

Amy M Schwartz ◽

Alison F Hinckley

Keyword(s):

United States ◽

Lyme Disease ◽

Standard Treatment ◽

Age Distribution ◽

Public Health Problem ◽

The United States ◽

Adverse Outcomes ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Low Incidence

Abstract Background Lyme disease (LD) is the most common vector-borne disease in the United States and is a significant public health problem. The use of non-standard antibiotic treatment regimens for LD has been associated with adverse effects; however, the overall landscape of treatment has not been described previously. We aimed to describe real-world antibiotic prescribing patterns for LD. Methods We performed a retrospective analysis of the MarketScan commercial claims database of outpatient encounters from 2016-2018 in the United States. We identified all individuals with a visit that included an LD diagnosis code and a prescription within 30 days of the visit for one or more of 12 antibiotics that may be prescribed for LD. We then categorized each individual as having received either standard or non-standard treatment during the two-year period. Standard treatment was defined as treatment with a first, second or third-line antibiotic for LD, for no longer than 30 days, and for no more than two episodes during the study period. Descriptive and multivariable analyses were performed to compare characteristics of people who received standard vs non-standard treatment for LD. Results A total of 84,769 prescriptions met criteria for inclusion, written for 45,926 unique patients. The mean duration of prescriptions was 21.4 days (SD 10.8). Most individuals (84.5%) treated for LD received standard treatment during the study period. Female gender (OR 1.5, p< 0.0001) and age 19-45 (p=0.0003) were significantly associated with being prescribed non-standard LD treatment. Treatment in low-incidence states (OR 2.2 compared to high-incidence states, p< 0.0001) and during non-summer months (OR 2.2, p< 0.0001) was more likely to be non-standard. Age distribution of patients receiving treatment for Lyme disease, by gender and age at first prescription Seasonality of standard versus non-standard treatment of Lyme disease Conclusion In this population of employed, young, and insured patients, young and middle-aged women were at the highest risk of receiving non-standard LD treatment. Treatments prescribed in states with low incidence of LD or during non-summer months were also more likely to be non-standard, a trend which likely reflects misdiagnosis or overtreatment of LD. Future studies are needed to further define prescriber and patient factors associated with non-standard LD treatment and related adverse outcomes. Disclosures All Authors: No reported disclosures

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Barriers that Nurse Practitioners Face as Primary Care Providers in the United States

Annals of Global Health ◽

10.1016/j.aogh.2017.03.250 ◽

2017 ◽

Vol 83 (1) ◽

pp. 112

Author(s):

C. Pando

Keyword(s):

United States ◽

Primary Care ◽

Nurse Practitioners ◽

Primary Care Providers ◽

The United States ◽

Care Providers

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Prescribing Patterns Among Radiation Oncologists in the United States

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.2441 ◽

2020 ◽

Vol 108 (3) ◽

pp. e398

Author(s):

B. Adefres ◽

T.Q. Huang ◽

F.I. Chu ◽

E.M. Chang ◽

A. Raldow

Keyword(s):

United States ◽

The United States ◽

Prescribing Patterns ◽

Radiation Oncologists

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Understanding the role of nurse practitioners, physician assistants and other nursing staff in HIV pre-exposure prophylaxis care in the United States: a systematic review and meta-analysis

BMC Nursing ◽

10.1186/s12912-020-00503-0 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Chen Zhang ◽

Warton Mitchell ◽

Ying Xue ◽

Natalie LeBlanc ◽

Yu Liu

Keyword(s):

United States ◽

Study Design ◽

Nurse Practitioners ◽

Nursing Staff ◽

Physician Assistants ◽

The United States ◽

Health Providers ◽

Physician Health ◽

Exposure Prophylaxis

Abstract Background Although pre-exposure prophylaxis (PrEP) was approved for primary HIV prevention by the Federal Drug Administration in 2012, PrEP utilization has been suboptimal. A body of literature and programs has emerged to examine the role of nurse practitioners (NPs), physician assistants and nursing staff in PrEP care. This review aims to understand the current status of non-physician health providers in PrEP care implementation in the United States. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance, we conducted a comprehensive literature search using multiple databases to identify peer-reviewed articles that examined the role of non-physician health providers in the implementation of PrEP. Four major databases of studies using observational study design, randomized control trials and mixed-method study design were screened from November 2019 to January 2020 were searched. Two independent reviewers examined eligibility and conducted data extraction. We employed random-effects model aims to capture variances of estimates across studies. Results A total of 26 studies with 15,789 health professionals, including NPs (18, 95% CI = 14,24%), physician assistants (6, 95% CI = 2, 10%), nursing staff (26, 95% CI = 18–34%), and physicians (62,95% CI = 45, 75%), were included in the analysis. The odds of prescribing PrEP to patients among NPs were 40% (OR = 1.40, 95% CI = 1.02,1.92) higher than that among physicians, while the likelihood of being willing to prescribe PrEP was similar. On the other hand, the odds of being aware of PrEP (OR = 0.63, 95% CI = 0.46, 0.87) was 37% less in nursing professionals than that among physicians. Conclusions Although the limited number and scope of existing studies constrained the generalizability of our findings, the pattern of PrEP care implementation among non-physician health providers was described. To achieve wider PrEP care implementation in the U.S., increasing awareness of PrEP among all health providers including both physicians and non-physicians is a key step.

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