Quality of Prescribing by Physicians, Nurse Practitioners, and Physician Assistants in the United States

Shiyin Jiao, Irene B. Murimi, Randall S. Stafford, Ramin Mojtabai, G. Caleb Alexander

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objective: 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. Methods: A serial cross-sectional analysis of the 2006–2012 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. Results: 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-converting 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)417-427
Number of pages11
Issue number4
StatePublished - Apr 2018


  • health care quality improvement
  • health care quality indicators
  • nurse practitioner's practice patterns
  • physician assistant's practice patterns
  • physician's practice patterns
  • prescribing patterns
  • quality of care

ASJC Scopus subject areas

  • Pharmacology (medical)


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