THE EFFECT OF LEGALIZED PRESCRIPTIVE AUTHORITY ON THE GERIATRIC PRESCRIBING PRACTICES OF NURSE PRACTITIONERS.
Contributors: Florence Heller Graduate School for Advanced Studies in Social Welfare.
Published: 1989
Number of pages: 222
Subjects: Health Sciences, Nursing.; Gerontology.
Description: Prescribing is an integral part of primary care practice. Since 1975, twenty-five states have enacted regulatory changes that allow nurses in advanced practice a range of prescription activities. Regulations, however, vary among the states and often leave nurse practitioners' (NPs) legal prescriptive status ambiguous. Policymakers and legislators are increasingly confronted with the issue of either granting NPs prescriptive authority or clarifying existing regulations. A clearer understanding of the implications of legalizing prescriptive authority for NPs is essential in order that policymakers and legislators can make informed decisions.

This dissertation analyzes the effect of regulatory constraints on NP prescriptive decisions by comparing a sample of 118 NPs with existing prescriptive authority to another sample of 178 NPs without this authority. Differences and similarities in prescribing patterns between the two groups are ascertained through the use of standardized hypothetical geriatric case vignettes. The analysis constructs an index of appropriate prescribing and tests the effects of a variation in regulatory prescriptive policies on NP's prescribing practices. The appropriateness of NP's prescriptive decision making is also contrasted with that of a comparison group of 373 physicians.

Data were obtained from a 1986 national random sample of the prescribing practices of physicians and NPs, surveyed by Louis Harris Associates. The appropriateness index was constructed using items agreed upon by a multi-disciplinary geriatric expert panel. A second survey of the panel was conducted that established guidelines for optimal geriatric prescribing. Statistical techniques included analysis of variance, t-tests, factor analysis, and ordinary least squares multiple regression analysis. A model was tested which posited that appropriate prescribing was a function of the prescriber's legal status, provider characteristics (educational preparation, type of NP, experience as a NP, and frequency of drug prescribing) and social forces (practice location, practice format, percentage of geriatric clients, caseload, and number of Medicaid clients).

As hypothesized, NP prescriptive authority (or lack thereof) had no effect on the appropriateness of prescribing; rather, significant determinants were the NPs' prescribing experience, geriatric experience, and graduate education. NPs both with and without prescriptive authorization demonstrated significantly higher levels of prescribing appropriateness than the physician comparison group. The results do not support concerns that granting NP's prescriptive authority will lower the quality of prescribing. Implications for state and federal policies, prescribing standards, and prescriber pharmacogeriatric education are detailed.
Notes: Source: Dissertation Abstracts International, Volume: 50-08, Section: B, page: 3402.

Thesis (PH.D.)--BRANDEIS U., THE F. HELLER GRAD. SCH. FOR ADV. STUD. IN SOC. WEL., 1989.

School code: 0541.