Prescriptive practice differences between nurse practitioners and physicians in the treatment of uncomplicated urinary tract infections in the emergency department setting

Abstract

Background: Nurse practitioners (NPs) have increasingly broad prescribing authority, yet there is insufficient information available on the prescribing practices of NPs working in the emergency department setting. Purpose: The purpose of this study was to describe prescriptive practices between two provider groups, NPs and physicians, in an emergency department setting in the United Arab Emirates. This comparison focused on treatment of a common emergency department diagnosis of uncomplicated urinary tract infection (UTI). Methods: The investigators reviewed a sample of 690 UTI patients during the period of August 30, 2016 to June 30, 2018. Physician and NP provider groups were then assessed for treatment selection and associated patient outcomes. A Chi-square test was used to compare empiric antibiotic selection using variables of population type, gender, age, and provider type. Results: There were similar prescriptive practices for beta-lactam, nitrofurantoin, and trimethoprim prescriptions. The investigators noted a statistical difference for fluoroquinolone use, with the physician group selecting fluoroquinolones more often than the NP group. Also, fluoroquinolone use within the physician group varied significantly; however, the investigators did not see this within the NP group. Implications for practice: The findings support that there is comparable care quality in the treatment of uncomplicated UTIs between physician providers and NPs in this setting. Comparing outcome similarities and differences on a commonly occurring medical problem in the emergency department provides an early look at the value-added services that NPs provide.

CPD providers can positively impact practice by better understanding how APNs are educated, licenced, and certified

“…Results have confirmed that NPs and physicians provide comparable care to a variety of patients in a variety of settings. For example, one study found that NPs and physicians provided comparable care when treating patients with uncomplicated urinary tract infections who had come to the emergency department [ 6 ]. NPs also have a positive effect on patient outcomes.…”

One size does not fit all: advanced practice provider considerations for the antimicrobial steward

“… 14 In these settings, several studies showed a higher rate of antibiotic prescriptions from APPs compared to physicians, while others showed no difference. 12 , 15 – 20 A more recent study in the VA healthcare system showed a decrease in outpatient antibiotic prescriptions from APP prescribers over time, even after independent prescribing privileges were granted at the VA. 21 …”

“…14 In these settings, several studies showed a higher rate of antibiotic prescriptions from APPs compared to physicians, while others showed no difference. 12,[15][16][17][18][19][20] A more recent study in the VA healthcare system showed a decrease in outpatient antibiotic prescriptions from APP prescribers over time, even after independent prescribing privileges were granted at the VA. 21 As noted, limited literature exists about APP prescribing for both non-antimicrobials and antimicrobials in the inpatient setting. One study of a multi-disciplinary orthopedic surgery teams at an academic medical center found that NPs and PAs were responsible for a similar amount of discharge opioid prescriptions as post-graduate years 1-3 residents; however, no studies have been published comparing inpatient antimicrobial prescriptions between APPs and other prescribers.…”