Nurse practitioner low-value care ordering practices: an integrative review

• Published in: The American journal of managed care 2024-03, Vol.30 (3), p.e93-e102
• Main Authors: Nugent, Sara B, Lavin, Roberta P, Holmes Damron, Barbara I
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Costs; Nurse practitioners; Patient education; Physician assistants; Primary care; Qualitative research
• ISSN: 1088-0224; 1936-2692; 1936-2692
• DOI: 10.37765/ajmc.2024.89520

Low-value care (LVC) health services are unsupported by current evidence, are associated with harmful patient outcomes, and equate to more than $100 billion in wasteful spending annually. Nurse practitioner (NP) LVC ordering practices among adult patients in outpatient settings are described and compared with those of other health care clinicians. Factors impacting NP ordering practices are also explored. Integrative review. Electronic databases, including MEDLINE's PubMed, CINAHL, Web of Science, and Business Source Complete, and Google Scholar were searched for original studies published prior to April 2023. Search terms included relevant keywords pertaining to LVC and NPs. Results were supplemented by a search of the reference lists of included studies. Of the 20 included studies, 7 were of low quality, which limited findings. Results comparing NP LVC ordering practices with those of other health care clinicians were conflicting. When compared with physicians, NPs ordered equal rates of antibiotics in 4 studies and lumbar imaging in 6 studies; they ordered less imaging in 2 studies but more imaging in 1 study. In 1 study, NPs ordered fewer lumbar imaging studies than physician assistants. NPs reported following protocols for prescribing and found that patient education and reassurance were successful in minimizing LVC ordering when managing patient expectations. NP specialization appeared to influence LVC ordering, whereas scope of practice laws had no effect. The full extent to which NPs order LVC services, as well as a comprehensive understanding of the factors influencing their decisions, remains unknown. It is unclear whether NPs order fewer or equal LVC services compared with other health care clinicians. More research on NPs and LVC is indicated.