Skip to main content

Advertisement

SpringerLink
Log in

An Examination of Prescribing Responsibilities between Psychiatrists and Primary Care Providers

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

Patients with comorbid mental health and chronic conditions often receive care from both psychiatrists and primary care physicians (PCPs). The introduction of multiple providers into the care process introduces opportunities for disruptions in care continuity. The purpose of this study was to explore psychiatrists’ and PCPs’ comfort prescribing, along with their comfort having other physician specialties prescribe medications for cardiometabolic, psychiatric, and neurological/behavioral conditions. This cross-sectional study utilized an online, validated, pilot-tested, anonymous survey to examine prescribing practices of psychiatrists and PCPs. Eligible participants included physicians with medical degrees, U.S. prescribing authority, and active patient care for ≥2 days/week. Outcomes of interest were physicians’ self-comfort and cross-specialty comfort (other specialists prescribing mutual patients’ medications) prescribing cardiometabolic, psychiatric, and neurological/behavioral medications. Comfort prescribing was measured using 7-point Likert scales. Discrepancies in comfort were analyzed using student’s, one-sample, and paired t-tests. Multiple linear regressions examined associations between physician practice characteristics and physicians’ comfort-level prescribing cardiometabolic and psychiatric medication categories. Among 50 psychiatrists and 50 PCPs, psychiatrists reported significantly lower self-comfort prescribing cardiometabolic medications (mean ± SD = 2.99 ± 1.63 vs. 6.77 ± 0.39, p < 0.001), but significantly higher self-comfort prescribing psychiatric medications (mean ± SD = 6.79 ± 0.41 vs. 6.00 ± 0.88, p < 0.001) and neurological/behavioral medications (mean ± SD = 6.48 ± 0.74 vs. 5.56 ± 1.68, p < 0.001) than PCPs. After adjusting for covariates, physician specialty was strongly associated with self-comfort prescribing cardiometabolic and psychiatric medication categories (both p < 0.001). Differences between self-comfort and cross-specialty comfort were identified. Because comfort prescribing medications differed by physician type, incorporating psychiatrists through collaborative methods with PCPs could potentially ensure comfort among physicians when initiating medications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

Individual requests should be sent to the corresponding author.

References

  1. Clyne B, Cooper JA, Hughes CM, Fahey T, Smith SM. 'Potentially inappropriate or specifically appropriate?' qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people. BMC Fam Pract. 2016;17:1–9.

    Article  Google Scholar 

  2. Druss BG, Walker ER. Mental disorders and medical comorbidity. The Robert Wood Johnson Foundation; Research Synthesis Report No. 2011: ISSN 2155–3718. 2011.

  3. Druss BG, Bradford WD, Rosenheck RA, Radford MJ, Krumholz HM. Quality of medical care and excess mortality in older patients with mental disorders. Arch Gen Psychiatry. 2001;58(6):565–72.

    Article  CAS  PubMed  Google Scholar 

  4. Salsberry PJ, Chipps E, Kennedy C. Use of general medical services among Medicaid patients with severe and persistent mental illness. Psychiatr Serv. 2005;56(4):458–62.

    Article  PubMed  Google Scholar 

  5. Lambert TJ, Newcomer JW. Are the cardiometabolic complications of schizophrenia still neglected? Barriers to care. Med J Aust. 2009;190(S4):S39–42.

  6. Cullinan S, Raae Hansen C, Byrne S, O'Mahony D, Kearney P, Sahm L. Challenges of deprescribing in the multimorbid patient. Eur J Hosp Pharm. 2017;24(1):43–6.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ong MS, Olson KL, Chadwick L, Liu C, Mandl KD. The impact of provider networks on the co-prescriptions of interacting drugs: a claims-based analysis. Drug Saf. 2017;40(3):263–72.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ong MS, Olson KL, Cami A, Liu C, Tian F, Selvam N, et al. Provider patient-sharing networks and multiple-provider prescribing of benzodiazepines. J Gen Intern Med. 2016;31(2):164–71.

  9. National Institute of Mental Health. Mental Illness. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154785. Published 2019. Accessed March 17, 2020.

  10. SSantillanes G, Axeen S, Lam CN, Menchine M. National trends in mental health-related emergency department visits by children and adults, 2009–2015. Am J Emerg Med. 2019.

  11. Olfson M, Wang S, Wall M, Marcus SC, Blanco C. Trends in serious psychological distress and outpatient mental health care of US adults. JAMA Psychiatry. 2019;76(2):152–61.

  12. Pincus HA, Tanielian TL, Marcus SC, Olfson M, Zarin DA, Thompson J, et al. Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties. JAMA. 1998;279(7):526–31.

  13. National Institute of Mental Health. Mental Health Medications. https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml. Published 2016. Accessed March 17, 2020.

  14. Mojtabai R, Olfson M. National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry. 2010;67(1):26–36.

    Article  PubMed  Google Scholar 

  15. Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999-2012. JAMA. 2015;314(17):1818–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Mojtabai R, Olfson M. Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Aff (Millwood). 2011;30(8):1434–42.

    Article  Google Scholar 

  17. Maust DT, Blow FC, Wiechers IR, Kales HC, Marcus SC. National Trends in antidepressant, benzodiazepine, and other sedative-hypnotic treatment of older adults in psychiatric and primary care. J Clin Psychiatry. 2017;78(4):e363–71.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rhee TG, Rosenheck RA. Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: rates, correlates, and national trends from 2006 to 2015. Health Serv Res. 2019;54(1):139–48.

    Article  PubMed  Google Scholar 

  19. Fraser K, Oyama O. Knowledge of psychotropics and prescribing preferences of family physicians: a preliminary study. Acad Psychiatry. 2013;37(5):325–8.

    Article  PubMed  Google Scholar 

  20. Rashid A, Llanwarne N, Lehman R. Prescribing for ADHD in primary care. Br J Gen Pract. 2018;68(669):170–1.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ostbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005;3(3):209–14.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Maciejewski ML, Hammill BG, Voils CI, et al. Prescriber continuity and medication availability in older adults with cardiometabolic conditions. SAGE Open Med. 2018;6:2050312118757388.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Maciejewski ML, Hammill BG, Bayliss EA, Ding L, Voils CI, Curtis LH, et al. Prescriber continuity and disease control of older adults. Med Care. 2017;55(4):405–10.

  24. Hansen RA, Voils CI, Farley JF, Powers BJ, Sanders LL, Sleath B, et al. Prescriber continuity and medication adherence for complex patients. Ann Pharmacother. 2015;49(3):293–302.

  25. Ploeg J, Yous ML, Fraser K, Dufour S, Baird LG, Kaasalainen S, et al. Healthcare providers' experiences in supporting community-living older adults to manage multiple chronic conditions: a qualitative study. BMC Geriatr. 2019;19(1):316.

  26. Schreiner A, Simpson K. Primary care and chronic disease: the intersection of comfort and specialty involvement - a cross-sectional study. J Eval Clin Pract. 2017;23(3):494–7.

  27. Chou C, Hohmann NS, Hastings TJ, et al. How comfortable are primary care physicians and oncologists prescribing medications for comorbidities in patients with cancer? Res Social Adm Pharm. 2020;16(8):1087–1094.

  28. Qualtrics. Panel management software. https://www.qualtrics.com/research-core/panel-management/ Accessed 28 Mar 2019.

  29. Young AS, Klap R, Sherbourne CD, Wells KB. The quality of Care for Depressive and Anxiety Disorders in the United States. Arch Gen Psychiatry. 2001;58(1):55–61.

    Article  CAS  PubMed  Google Scholar 

  30. Weisberg RB, Dyck I, Culpepper L, Keller MB. Psychiatric treatment in primary care patients with anxiety disorders: a comparison of care received from primary care providers and psychiatrists. Am J Psychiatry. 2007;164(2):276–82.

    Article  PubMed  Google Scholar 

  31. Seaman JJ, Cornfield RM, Cummings DM, Peterson CW, Lyon J. Exploring psychiatric prescribing practices: the relationship between the role of the provider and the appropriateness of prescribing. Gen Hosp Psychiatry. 1987;9(3):220–4.

    Article  CAS  PubMed  Google Scholar 

  32. Wake L-A, Balon R. Should psychiatrists prescribe nonpsychotropic medications? Curr Psychiatr Ther. 2019;18:52–6.

    Google Scholar 

  33. Chang LS, Vaduganathan M, Plutzky J, Aroda VR. Bridging the gap for patients with diabetes and cardiovascular disease through Cardiometabolic collaboration. Curr Diab Rep. 2019;19(12):157.

    Article  PubMed  Google Scholar 

  34. Colorafi K, Vanselow J, Nelson T. Treating anxiety and depression in primary care: reducing barriers to access. Fam Pract Manag. 2017;24(4):11–6.

    PubMed  Google Scholar 

  35. Curkovic M, Dodig-Curkovic K, Eric AP, Kralik K, Pivac N. Psychotropic medications in older adults: a review. Psychiatr Danub. 2016;28(1):13–24.

    PubMed  Google Scholar 

  36. Boyd C, Smith CD, Masoudi FA, Blaum CS, Dodson JA, Green AR, et al. Decision making for older adults with multiple chronic conditions: executive summary for the American Geriatrics Society guiding principles on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2019;67(4):665–73.

Download references

Acknowledgements

The authors acknowledge Dr. Marisa Elena Domino at University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, and Dr. Matthew L. Maciejewski at Duke University, School of Medicine for their contributions in the process of completing the study.

Funding

This work was supported by the Auburn University Research Initiative in Cancer (AURIC), but investigator time was not supported. The sponsor of this study played no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, editing, or censuring of the manuscript.

Author information

Author notes

  1. Chiahung Chou and Cassidi C. McDaniel contributed equally to this work and shared co-first authorship

Authors and Affiliations

  1. Department of Health Outcomes Research and Policy, Auburn University, Harrison School of Pharmacy, 4306 Walker Building,, Auburn, AL, 36849, USA

    Chiahung Chou, Cassidi C. McDaniel, John David Abrams & Richard A. Hansen

  2. Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan

    Chiahung Chou

  3. Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, MN, USA

    Joel F. Farley

Authors
  1. Chiahung Chou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cassidi C. McDaniel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John David Abrams
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joel F. Farley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard A. Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Funding acquisition and study conceptualization were completed by Hansen. Data collection, data analysis and interpretation were performed by Chou, McDaniel, Abrams, Farley, and Hansen. Chou supervised the formal investigation. The first draft of the manuscript was written by McDaniel and all authors commented on, reviewed, and edited previous versions of the manuscript thoroughly. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Chiahung Chou.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

The study protocol was approved by Auburn University’s Institutional Review Board.

Consent to Participate

Initiation of the anonymous survey justified as informed consent.

Consent for Publication

Initiation of the anonymous survey justified as informed consent.

Code Availability

Individual requests should be sent to the corresponding author.

Previous Presentation

Findings were presented at the American Association of Colleges of Pharmacy (AACP) Annual Meeting in July 2020.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chou, C., McDaniel, C.C., Abrams, J.D. et al. An Examination of Prescribing Responsibilities between Psychiatrists and Primary Care Providers. Psychiatr Q 92, 587–600 (2021). https://doi.org/10.1007/s11126-020-09828-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-020-09828-0

Keywords

Search

Navigation