The Medicare program is anticipating an increase from 54 million beneficiaries today to over 80 million beneficiaries by 2030, many of whom will have longer life expectancies, chronic conditions, mental health problems, and substance use disorders. These population changes will challenge a primary care workforce already in need of more gero-psychiatrists.
Research by our team suggests that prescribing for behavioral health medications varies substantially between nurse practitioners and physicians who provide care to Medicare beneficiaries. Other research suggests that prescription drugs for behavioral health conditions are increasing for older adults, even in the absence of a documented psychiatric condition.
We will conduct descriptive analyses and regression analyses to examine how prescribing patterns differ for beneficiaries receiving care primarily from gero-psychiatrists versus primary care providers versus other specialists. We will use Medicare administrative data (Parts A, B, and D) for a sample of beneficiaries with behavioral health diagnoses and who have filled prescriptions for anti-depressants, psychotherapeutic agents, or anti-psychotics. We will identify the provider specialty through the National Provider Identification (NPI) number recorded on the prescription claim. Medispan data will be used to identify behavioral medications by drug class. We will use provider attribution methods from earlier work to determine whether gero-psychiatrist, other specialties or primary care providers serve as the primary behavioral health prescriber.
- What is the composition of providers who prescribe behavioral health medications, such as anti-depressants, psychotherapeutic agents, and anti-psychotics, to Medicare beneficiaries?
- What is the quantity and volume of prescriptions from gero-psychiatrists, primary care providers and other specialists for beneficiaries with behavioral health diagnoses?
- Has the composition of providers who provide prescriptions for Medicare beneficiaries with behavioral health needs changed over the last 5 years?
- How does the length of the patient-provider relationship affect the quantity, volume, and prescribing of behavioral health medications?
Muench, U, Jura, M, Thomas, C.P., Perloff, J, Spetz, J. Rural-urban prescribing patterns by primary care and behavioral health providers in older adults with serious mental illness. BMC Health Services Research, 22, 1440 (2022).
For questions, contact: Ulrike Muench, PhD, RN, Professor, Department of Social and Behavioral Sciences.