Nurse Practitioners (NP) prescribe as safely as physicians, a large study of the prescribing records of more than 73,000 primary care physicians and NPs found.

The analysis, published in the Annals of Internal Medicine, is believed to be the largest of its kind, though other studies comparing quality of care between NPs and physicians have reached similar conclusions, including one that examined prescribing practices for more than 2 million primary care visits.

The new comparison examined prescribing patterns for Medicare patients between 2013 and 2019 using the Beers Criteria  to identify inappropriate prescriptions. The researchers, from the University of California, Los Angeles (UCLA) and Stanford University, chose to focus on patients 65 and older because of the completeness of Medicare’s records and the fact that this age group of patients receive such a large share of prescription medications, according to a press statement from Stanford Medicine.

The records were from 23,669 NPs and 50,060 primary care physicians who wrote prescriptions for more than 100 patients a year in 29 states that had granted NPs full prescriptive authority by 2019.

Both NPs and physicians averaged about 1.7 inappropriate prescriptions per 100 written.

NPs, however, were overrepresented at both the highest and lowest levels. Researchers also noted that discrepancies tended to be larger among states than between practitioner types within states.

“Although we found that the average rate of inappropriate prescribing among NPs and physicians was similar, we also found that NPs were over-represented among the best performers and the worst performers,” said Johnny Huynh, doctoral student in economics at UCLA. “Those lower performers warrant attention from the hospitals, clinics and professional regulators that oversee their care.”

However, the variation of prescribing practices among states, rather that between clinicians, led the researchers to suggest that this might be a more appropriate focus for improvement.

“If expanding patient access while ensuring quality and safety systemwide is the goal, fixation on the question of whether NPs or other nonphysician providers should be allowed to prescribe may be less impactful than identifying and addressing deficient performance among all clinicians who prescribe, regardless of practitioner type or practice location,” they wrote.

An editorial from two other UCLA professors accompanying the study made a similar point.

“States that are holding off conferring prescriptive authority on nurse practitioners because of concerns about quality of care should think again,” Huynh added, in a statement from Stanford Medicine, where he had previously been a Health Policy research assistant.