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Psychotropic Drug Prescriptions by Medical Specialty Tami L. Mark, Ph.D., M.B.A. Katharine R. Levit Jeffrey A. Buck, Ph.D.
T
he important role of general practitioners in prescribing antidepressant medications and treating depression has been documented. However, the extent to which general practitioners are prescribing other types of psychotropic medications has received less emphasis. This study used data from August 2006 to July 2007 from the National Prescription Audit (NPA) Plus database of IMS to examine this question. IMS collects transaction information each month from approximately 36,000 retail pharmacies, representing about 70% of all retail pharmacies, which when weighted represent all prescriptions filled in retail outlets in the United States. Using a separate sample of retail pharmacy transactions that includes the physician’s Drug Enforcement Administration number, IMS assigns physician specialty information to obtain an estimate of the total number of prescriptions filled in retail pharmacies by medical specialty. As shown Figure 1, of the 472 million prescriptions for psychotropic medications, 59% were written by general practitioners, 23% by psychiatrists, and 19% by other physicians and nonphysician providers. General practitioners wrote prescriptions for 65% of the anxiolytics in the sample, 62% of the antidepressants, 52% of the stimu-
lants, 37% of the antipsychotics, and 22% of the antimania medications. Conversely, psychiatrists and addiction specialists wrote prescriptions for 66% of the antimania medications, 49% of the antipsychotics, 34% of the stimulants, 21% of the antidepressants, and 13% of the anxiolytics. Pediatricians were included as general practitioners and wrote 25% of all stimulant prescriptions but only 3% of all other types of psychotropic medications (data not shown). Prescribing of psychotropic medications by nonpsychiatrists improves access to treatment. However, concerns remain about whether patients treated in the general medical setting are receiving treatment concordant with evidence-based guidelines, psychotherapy, adequate medication monitoring, and appropriate intensity of treatment.
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Acknowledgments and disclosures This study was funded through a contract from the Substance Abuse and Mental Health Services Administration. The authors report no competing interests.
Reference 1. Cunningham PJ: Beyond parity: primary care physicians’ perspectives on access to mental health care. Health Affairs 28:w490–w501, 2009
Figure 1
Percentage of U.S. retail psychotropic prescriptions written from August 2006 to July 2007, by type of providera Psychiatrists and addiction specialists General practitioners, obstetriciangynecologists, and pediatricians
100
13% 6%
80
6% 6% 22%
Physician assistants and nurse practitioner All other specialties and psychologists
8%
9%
11%
6%
5%
6%
37%
52%
59%
62%
17%
5% 65%
66%
60
Dr. Mark and Ms. Levit are affiliated with Thomson Reuters, 4301 Connecticut Ave., N.W., Suite 330, Washington, DC 20008 (e-mail:
[email protected]). Dr. Buck is with the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Amy M. Kilbourne, Ph.D., M.P.H., and Dr. Mark are editors of this column.
In 2004–2005, about two-thirds of primary care physicians reported that they were unable to obtain outpatient mental health services for patients (1). Given the large role of primary care providers in psychotropic drug prescribing, additional efforts may be needed to enhance the quality of psychiatric treatment in general practice settings across a range of psychiatric conditions.
49%
40
34%
20
23%
21% 13%
0
a
Total (N=472,173)
Antimania (N=4,163)
Antipsychotics Stimulants Antidepressants Anxiolytics (N=53,328) (N=35,634) (N=232,660) (N=146,388)
Ns represent prescriptions in thousands
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