A study run by telehealth giant Eucalyptus found both types of prescribers made high-risk errors in about 1.5% of consults.
Nurse practitioners are no better or worse than GPs when it comes to prescribing via telehealth, according to data from online clinic group Eucalyptus – but it isn’t about to replace its GPs.
Published last month in Nursing Reports, the study looked at six months’ worth of quality and safety audits from GP and nurse practitioner prescribers across its five Australian telehealth clinics.
The sample included data from 8359 audits completed between October 2023 and March 2024, around three quarters of which were from telehealth consults run by nurse practitioners.
This is not because nurse practitioners were doing 75% of consults at that time.
“Auditing is done on a range of consultations, including a high volume completed when a practitioner first starts with us,” Eucalyptus clinical director Dr Matt Vickers, who co-authored the article, told The Medical Republic.
“During the study period, we had a higher volume of [nurse practitioners] start with us and so this has skewed the relevant volume of consultations audited in favour of the [nurse practitioners].”
The cohort error rate for nurse practitioners was around 14%, while GPs made errors about 21% of the time.
Doctors working with Eucalyptus are required to either have GP fellowship or be at least four years post-graduation.
Of course, not all errors are created equal; less than 1% of GP and nurse practitioner consults had errors which were considered “never events”, while 1.6% of nurse practitioner consults and 1.4% of GP consults had errors that were considered high-risk.
So-called never events included instances with risk of permanent harm, such as a patient with a history of pancreatitis being prescribed liraglutide, while high-risk events were those with temporary major harm or permanent consequences, like a patient with congestive cardiac failure being prescribed minoxidil without counselling.
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While the study states that its findings “suggest that [nurse practitioners] can prescribe medications with a comparable degree of safety to GPs across a range of conditions in digital settings”, Dr Vickers said nurse practitioners still performed a minority of patient consults.
“Currently, about 25-40% of consultations are performed by [nurse practitioners], but this is variable as we have a number of casual and part-time staff,” he said.
One of the bigger questions raised by the study, though, is whether a 1.5% error rate is high or not.
The paper itself noted that 1.5% “appears a little high”, but conceded that there was no baseline with which to compare it.
Dr Vickers said told TMR there was a “very real lack of literature” relating to rates of prescribing errors in Australian primary care.
“The intention of the study was to demonstrate the prescribing error rate in a telehealth model of care with a mixed workforce, operating within the same clinical protocols and guidelines, supported by our technology platform,” he said.
“As expected, it has shown that prescribing errors are generally rare across our platforms and that clinicians are providing safe care, irrespective of their background.
“This highlights that with appropriate clinical governance, including with respect to scope of practice and support, nurse practitioners remain an integral part of our primary healthcare system.”
Nurse practitioners were recently released from the requirement to have a collaborative care arrangement in place with a doctor in order to bill the MBS or write PBS-eligible prescriptions.
Because Eucalyptus primarily offers asynchronous consults, which are not supported on the MBS, and offers private scripts only, meaning it avoids the PBS, its nurse practitioners have never had to be subject to collaborative arrangements by law.
