More on the New Specialists

In the Journal Medical Care, (April 18,2019), Muensch, Spets, Jura et al. described their research involving opioid prescribing outcomes of medicare beneficiaries managed by nurse practitioners and physicians. The medicare data they used was from 2009-2013. The research was directed toward prescribing behavior and not toward clinical outcomes. The practitioners used were primary care providers. The beneficiaries were medicare subscribers who resided in states where nurse practitioners were able to practice without physician supervision and who did not have biomedical support. The subjects were all medicare beneficiaries (which is a certain age group), and did not have a cancer diagnosis. None of the subjects were in hospice care and none of them suffered from end-stage renal disease. It appears that the nurse practitioners were less likely to prescribe opioids initially but were prescribing a higher daily dose (measured in morphine milligram equivalents) than physicians.

The researchers concluded that educational programs and clinical guidelines "require approaches tailored to different providers" and need to be made available.

This study also collaborated with the University of California School of Nursing, the Lee Institute for Health Policy at the University of California San Francisco, the Institute of Biomedical Informatics, National Yang Min University Taipei, Taiwan, Chinese University of Hong Kong and the Heller School of Brandeis University.

The collaborative nature of this piece of research is striking and in itself indicative of the need for collaboration in supplying solutions or improvement in the handling of identified problems. Primary care providers are at the center of the opioid epidemic in the USA and to some extent may be partially to blame for its proliferation. Until the epidemic is better-managed, you, the patient, need to collaborate with your healthcare provider. You need to ask about the addictive potential of any medication prescribed for pain. You need to determine whether or not you are seeking a refill for actual pain or for the fleeting euphoria of a given medication. Parenthetically, think about the significance of being a medicare beneficiary and think about your distance from eligibility and how you can fill that gap.

Do what you can (and only you can) to avoid health-damaging practices like smoking, vaping,  and excessive alcohol consumption. Also, avoid requiring an euphoriant to socialize, relax or destress. Be aware of when you are censoring information when speaking to your healthcare provider. Ask your physician about healthcare, even to the point of why he does or doesn't accept certain plans.