ArticleBMC health services research2022
Rural-urban prescribing patterns by primary care and behavioral health providers in older adults with serious mental illness.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- The effectiveness of nurse practitioner care for patients with mental health conditions in primary care settings: A systematic review.Nursing outlookPooled it
- Comparing Physicians' Perceptions of Access to Behavioral Health Resources in Rural and Urban Practices.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- The hidden costs of becoming a nurse: how student debt deepens inequities in the nursing workforce pipeline.Health affairs scholar · 2026Article
- Exploring the COVID-19 pandemic's impact on mood, anxiety, and neurocognitive disorders in older adults: sex, geographic context, and healthcare setting considerations.Social psychiatry and psychiatric epidemiology · 2026Article
- Sleep quality and life satisfaction in urban-dwelling solitary Chinese older adults: a study of parallel mediation by depression and cognitive function.Frontiers in aging · 2026Article
- Gender differences in psychotropic medication prescribing in a rural area of Catalonia: a community-based observational study.Frontiers in public health · 2026Observational
- Guideline-Concordant Care and Clinician and Clinic Characteristics for Patients With Schizophrenia.JAMA network open · 2025Article
- Differences in rural and urban treatment of postpartum depression and anxiety in the United States.Pregnancy (Hoboken, N.J.) · 2025Article
- Engineering Integrated Care Expansion and Innovation: Drawing upon Nursing Leadership.International journal of environmental research and public health · 2025Article
- The Association between the Type of Mental Health Treatment Received, Metropolitan Status and Gender.Community mental health journal · 2025Article
- Mental health literacy among primary care providers in Hungary: a vignette-based survey.Annals of general psychiatry · 2025Article
- Tracking 5-Year Trends in the Workforce Prescribing Psychotropics and Medications for Opioid Use Disorder: A Cross-Sectional Study.Journal of general internal medicine · 2024Article
- A population-based analysis of the management of symptoms of depression among patients with stage IV non-small cell lung cancer (NSCLC) in Ontario, Canada.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024Article
- Antidepressant Prescription Behavior Among Primary Care Clinician Providers After an Interprofessional Primary Care Psychiatric Training Program.Administration and policy in mental health · 2023Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOlder adults with serious mental illness (SMI) often have multiple comorbidities and complex medication schedules. Shortages of behavioral health specialists (BHSs), especially in rural areas, frequently make primary care providers (PCPs) the only clinician managing this complex population. The aim of this study was to describe rural/urban psychiatric medication prescribing in older adults with SMI by PCPs and BHSs, and by clinician type.
methodsThis retrospective descriptive analysis used 2018 Medicare data to identify individuals with a bipolar, major depression, schizophrenia, or psychosis diagnosis and examined medication claims for antianxiety, antidepressants, antipsychotics, hypnotics, and anticonvulsants. Descriptive statistics summarized percentage of medications provided by PCPs and BHSs stratified by rural and urban areas and by drug class. Additional analyses compared psychiatric prescribing patterns by physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs).
resultsIn urban areas, PCPs prescribed at least 50% of each psychiatric medication class, except antipsychotics, which was 45.2%. BHSs prescribed 40.7% of antipsychotics and less than 25% of all other classes. In rural areas, percentages of psychiatric medications from PCPs were over 70% for each medication class, except antipsychotics, which was 60.1%. Primary care physicians provided most psychiatric medications, between 36%-57% in urban areas and 47%-65% in rural areas. Primary care APRNs provided up to 13% of prescriptions in rural areas, which was more than the amount prescribed by BHS physicians, expect for antipsychotics. Psychiatric mental health APRNs provided up to 7.5% of antipsychotics in rural areas, but their prescribing contribution among other classes ranged between 1.1%-3.6%. PAs provided 2.5%-3.4% of medications in urban areas and this increased to 3.9%-5.1% in rural areas.
conclusionsResults highlight the extensive roles of PCPs, including APRNs, in managing psychiatric medications for older adults with SMI.
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