Yang Bo Kyum, Burcu Mehmet, Safer Daniel J, Trinkoff Alison M, Zito Julie M
Department of Interprofessional Health Studies, Towson University, Towson, Maryland.
Pharmaceutical Health Services Research Department, University of Maryland, Baltimore, Maryland.
J Child Adolesc Psychopharmacol. 2018 Apr;28(3):166-172. doi: 10.1089/cap.2017.0112. Epub 2018 Mar 13.
To describe psychotropic medication prescribing practices of nurse practitioners (NP) and physicians for Medicaid-insured youths in 2012-2014 in a mid-Atlantic state where NP independent prescribing is authorized. From annual computerized administrative claims data in a mid-Atlantic state, we analyzed 1,034,798 dispensed psychotropic medications prescribed by NPs and physicians for 61,526 continuously enrolled Medicaid-insured youths aged 2-17 years. Demographic and clinical characteristics of psychotropic medication users were compared for youths who received psychotropic medication dispensings by NP-only, physician-only, or by both providers using descriptive statistics and generalized estimating equations. We then characterized psychotropic medication prescribing practices by providers within each specialty. From 2012 to 2014, the number of psychotropic medication dispensings increased from 346,922 to 349,080. There was a 50.9% increase in the proportion of psychotropic medications prescribed by psychiatric NPs (from 5.9% to 8.8%) and a 28.6% proportional increase by non-psychiatric NPs (from 4.9% to 6.3%). By contrast, the proportion of psychotropic medications prescribed by psychiatrists and by non-psychiatric physicians declined (56.9%-53.0% and 32.3%-31.8%, respectively). Youths diagnosed with depression or anxiety were more commonly treated by NP-only than by physician-only (AOR = 1.33, 95% CI = 1.24-1.43), whereas youths with two or more psychiatric comorbidities were significantly more commonly treated by both NP and physician providers (AOR = 1.44, 95% CI = 1.39-1.50). Psychiatric specialists prescribed the bulk of antidepressants (82.0%) and lithium (92.3%), with much lower prescribing by non-psychiatric specialists (18.0% and 7.7%, respectively). Antipsychotic orders originated from psychiatric specialists 7.4 times more than from their non-psychiatric specialty counterparts, whether physician or NP. NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention.
描述2012 - 2014年在大西洋中部一个授权执业护士（NP）独立开处方的州，执业护士和医生为参加医疗补助计划的青少年开具精神药物的处方情况。我们从大西洋中部一个州的年度计算机化行政索赔数据中，分析了执业护士和医生为61,526名年龄在2至17岁、连续参保医疗补助计划的青少年开具的1,034,798份已配发精神药物处方。使用描述性统计和广义估计方程，对仅由执业护士、仅由医生或由两者提供精神药物配发服务的青少年的人口统计学和临床特征进行了比较。然后我们按各专业领域内的提供者来描述精神药物的处方情况。2012年至2014年，精神药物的配发数量从346,922份增加到349,080份。精神科执业护士开具的精神药物比例增加了50.9%（从5.9%增至8.8%），非精神科执业护士开具的比例增加了28.6%（从4.9%增至6.3%）。相比之下，精神科医生和非精神科医生开具的精神药物比例下降（分别从56.9%降至53.0%和从32.3%降至31.8%）。被诊断为抑郁或焦虑的青少年由仅执业护士治疗的情况比仅由医生治疗更为常见（比值比[AOR] = 1.33，95%置信区间[CI] = 1.24 - 1.43），而患有两种或更多精神疾病合并症的青少年由执业护士和医生共同治疗的情况显著更为常见（AOR = 1.44，95% CI = 1.39 - 1.50）。精神科专科医生开具了大部分抗抑郁药（82.0%）和锂盐（92.3%），非精神科专科医生的开具比例则低得多（分别为18.0%和7.7%）。无论是医生还是执业护士，抗精神病药物处方来自精神科专科医生的是来自非精神科专科医生的7.4倍。相对于医生而言，执业护士在为参加医疗补助计划的青少年开具精神药物方面发挥着越来越大的作用。执业护士的处方质量值得进一步关注。
