Medical Care最新文献

{"title":"The Impact of the COVID-19 Pandemic on Registered Nurse Employment Across Settings.","authors":"Charlotte Ahr, Claudia Gates, Thuy D Nguyen, Christopher R Friese, Milisa Manojlovich, Matthew A Davis","doi":"10.1097/MLR.0000000000002294","DOIUrl":"10.1097/MLR.0000000000002294","url":null,"abstract":"<p><strong>Background: </strong>It is unknown whether the stress of the COVID-19 pandemic, which had a particular impact on inpatient and long-term care (LTC) nurses, had an effect on nurses' choice of employment settings.</p><p><strong>Objective: </strong>Determine whether the COVID-19 pandemic contributed to changes in nurses' choice of employment setting.</p><p><strong>Methods: </strong>This study used data from the 2018 and 2022 National Sample Survey of Registered Nurses to conduct a difference-in-difference analysis. We constructed a state-level measure of COVID-19 caseload, defined as COVID-19 cases per hospital bed; High versus Low COVID-19 states were defined as those above versus below the median, respectively. Logistic regression models were used to estimate the effect of exposure to High COVID-19 caseload (vs. Low) and time (2022 vs. 2018) on nurse employment choices across inpatient, LTC, outpatient, and nonclinical settings.</p><p><strong>Results: </strong>From 2018 to 2022, the size of the US nursing workforce grew from 3.27 to 3.57 million nurses; however, RN FTEs increased in outpatient settings and decreased in all other settings. In adjusted analyses, nurses were less likely to work in LTC settings in 2022 than in 2018; yet, those exposed to High COVID-19 caseloads were 0.9% (95% CI: 0.3-1.5) more likely to work in LTC than those exposed to Low COVID-19 caseloads. Differences between High versus Low COVID-19 caseload exposure were not statistically significant for the likelihood of working in inpatient, outpatient, and nonclinical settings.</p><p><strong>Conclusions: </strong>Our findings suggest that exposure to High COVID-19 caseload was not associated with changes in nurses' employment settings.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"274-282"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adding Self-Care Complementary and Integrative Health Therapies to Care for Chronic Pain: The Assessing Pain, Patient Reported Outcomes and Complementary Health (APPROACH) Study.","authors":"Steven B Zeliadt, Scott S Coggeshall, Barbara Bokhour, A Rani Elwy, Benjamin Kligler, Claudia Der-Martirosian, Ethan W Rosser, Marlena Shin, Joy Toyama, Michelle L Upham, Xiaoyi Zhang, Stephanie L Taylor","doi":"10.1097/MLR.0000000000002295","DOIUrl":"10.1097/MLR.0000000000002295","url":null,"abstract":"<p><strong>Background: </strong>Health care systems and insurers are expanding coverage for practitioner-delivered and self-care complementary and integrative health (CIH) therapies for chronic pain.</p><p><strong>Objectives: </strong>To determine if combining practitioner-delivered and self-care CIH therapies (PD/SC-CIH) improves pain outcomes more than practitioner-delivered CIH (PD-CIH) therapies alone.</p><p><strong>Research design: </strong>Pragmatic nonrandomized trial. Structural nudges and the availability of CIH therapies were used as a surrogate to randomization.</p><p><strong>Subjects: </strong>Of 3306 veterans with chronic musculoskeletal pain at 18 medical centers in the Veterans Health Administration between March 2021 and March 2023.</p><p><strong>Measures: </strong>PD-CIH therapies included acupuncture, chiropractic care, or massage therapy. Participants in the PD/SC-CIH arm also received yoga, mindfulness/meditation, and/or Tai Chi/Qigong. The primary outcome was the change in pain-related functional interference at 6 months.</p><p><strong>Results: </strong>Pain interference improved in both arms (-0.62 and -0.70), with 39.5% and 41.1%, respectively, achieving clinically meaningful improvement with no difference between arms in improvement in pain interference: -0.12 (-0.28 to 0.05). At 6 months, more participants in the PD/SC-CIH arm reported their use of CIH therapies specifically led to perceived improvements across 4 global patient-centered measures: pain (11%; 5%-18%); fatigue (28%; 17%-40%); mental health (24%; 14%-35%); and overall well-being (27%; 18%-35%).</p><p><strong>Conclusions: </strong>Both approaches to offering CIH therapies were equally associated with improvements in pain interference among this large cohort with real-world CIH therapy engagement. More patients in the PD/SC-CIH arm perceived that their use of CIH therapies improved multiple health dimensions. Patients with chronic musculoskeletal pain should be encouraged to add self-care CIH therapies and health care systems should expand their availability.</p><p><strong>Study registration: </strong>ClinicalTrials.gov Identifier: NCT05097521.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"283-292"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147344648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatiotemporal Disparities in Stroke Mortality From 1969 to 2020, by Race and Sex, in Tennessee.","authors":"Shongkour Roy, Fawaz Mzayek, Ashish Joshi, Xinhua Yu","doi":"10.1097/MLR.0000000000002277","DOIUrl":"10.1097/MLR.0000000000002277","url":null,"abstract":"<p><strong>Background: </strong>Tennessee ranks sixth in stroke mortality in the United States. Yet the patterns of stroke mortality vary significantly across counties and over time.</p><p><strong>Objectives: </strong>This study aims to examine spatiotemporal disparities of stroke mortality at the county level in Tennessee from 1969 to 2020.</p><p><strong>Research design: </strong>A population-based study using the national vital statistics system of stroke mortality data through the Surveillance, Epidemiology, and End Results and National Center for Health Statistics (SEER-NCHS) database.</p><p><strong>Subjects: </strong>Patients older than 35 years who died from stroke in Tennessee from 1969 to 2020.</p><p><strong>Methods: </strong>Data from the SEER-NCHS were aggregated into 4 periods (1969-1980, 1981-1992, 1993-2004, and 2005-2020), and age-adjusted stroke mortality rates were calculated by county and by race and sex for each time period.</p><p><strong>Results: </strong>The stroke mortality rates in Tennessee declined by 35.6%, 28.3%, 7.1%, and 24.4% in 1969-1980, 1981-1992, 1993-2004, 2005-2020, respectively. The degree of decline varied by race and sex groups. In the first 2 periods, the largest decline in stroke mortality was observed among Black women (43.2% and 31.5%). During 1993-2004, the largest decline was observed among Black men (22.4%), while the largest decline was observed among white women during 2005-2020 at 25.5%. There were urban-rural disparities in stroke mortality across counties and over the 4 periods. In general, urban and rural mortality rates were similar from 1969 to 1992; however, a substantial decline (24.1%) was observed in urban counties during 1993-2004, while a larger decline (34.6%) occurred later in rural counties during 2005-2020. County-level variations in stroke mortality were also evident across the 4 periods.</p><p><strong>Conclusion: </strong>Substantial disparities in stroke mortality by counties and race-sex subgroups persisted over the past 5 decades. The disease burden was clustered in a few counties and disproportionately higher among vulnerable populations.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"268-273"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145857106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Income Inequality Within 8 Health Care Professions in the United States.","authors":"Ioana Popovici, Manuel J Carvajal","doi":"10.1097/MLR.0000000000002301","DOIUrl":"10.1097/MLR.0000000000002301","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigated intraoccupational income and wage-rate distributions across 8 health care professions: physicians and surgeons, dentists, physician assistants, optometrists, pharmacists, nurse practitioners and nurse midwives, physical therapists, and registered nurses.</p><p><strong>Methods: </strong>The research was based on a sample of 142,527 U.S. practitioners from the 2019 to 2022 American Community Survey (ACS) and focused on 4 inequality indicators: the coefficient of variation, lower median share, 90-10 decile ratio, and Gini coefficient.</p><p><strong>Results: </strong>Findings revealed substantial income dispersion, with dentists and physicians/surgeons displaying the highest levels of inequality, while pharmacists, registered nurses, physical therapists, and nurse practitioners and nurse midwives exhibited more even distributions. The occupations' degree of inequality was correlated with average annual income and wage-rate levels. Gender disparities were significant across all professions, with male practitioners consistently earning more than their female counterparts. The degree of inequality was greater for professions in which there were more male than female practitioners. Annual income and wage-rate inequality also was identified within genders.</p><p><strong>Conclusions: </strong>This research contributes to understanding income disparities within health care professions and suggests that further exploration is needed to identify the determinants of these inequalities and their long-term evolution.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"318-325"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth Uptake and Rural-Urban and Racial/Ethnic Disparities in Postpartum Care Access Among Medicaid Beneficiaries in South Carolina, 2018-2022.","authors":"Anirban Chatterjee, Xuzhuo Zhao, Jihong Liu, Berry A Campbell, Jiani Yu, Nansi S Boghossian, Bo Cai, Xiaoming Li, Peiyin Hung","doi":"10.1097/MLR.0000000000002298","DOIUrl":"10.1097/MLR.0000000000002298","url":null,"abstract":"<p><strong>Background: </strong>Although telehealth is increasingly being used for providing postpartum care, its role in ensuring timely postpartum care initiation in racial/ethnic minorities and rural residents is unknown.</p><p><strong>Objectives: </strong>To compare attendance and timeliness of postpartum care initiation by pandemic exposure and telehealth uptake across race/ethnicity and rural-urban residences.</p><p><strong>Research design: </strong>Retrospective cohort study.</p><p><strong>Subjects: </strong>Medicaid-insured individuals who gave birth in South Carolina between January 1, 2018, and September 30, 2022, were aged 15-49 years, and were followed up until December 31, 2022.</p><p><strong>Measures: </strong>Cox proportional hazards models examined associations between pandemic exposures, telehealth uptake, and racial/ethnic and rural/urban disparities in postpartum care initiation timeliness.</p><p><strong>Results: </strong>Median time to postpartum care initiation was 25 days [interquartile range (IQR): 14-41 d] with variations across race/ethnicity and residence. Fully-exposed nontelehealth users had slower initiation [adjusted hazard ratio (aHR): 0.95; 95% CI: 0.91-1.00], while telehealth users had quicker initiation (aHR: 2.19; 95% CI: 1.93-2.48) compared with non- or partially-exposed individuals. Among minimal- or no-telehealth users, postpartum care initiation was slower for Hispanic and non-Hispanic Black individuals compared with their non-Hispanic White peers. There were no differences in timely care initiation by race or residence among fully-exposed telehealth users.</p><p><strong>Conclusions: </strong>Telehealth may improve racial/ethnic disparities in timely postpartum care initiation. Rural-urban disparities in initiating timely postpartum care still warrant further investigation.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"298-309"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13056415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Nursing Has Not Returned to Pre-COVID Conditions: Time for a Different Approach.","authors":"Karen B Lasater, Matthew D McHugh, Linda H Aiken","doi":"10.1097/MLR.0000000000002296","DOIUrl":"10.1097/MLR.0000000000002296","url":null,"abstract":"<p><strong>Background: </strong>Hospital nurse burnout, job dissatisfaction, and intent to leave were high before the COVID-19 pandemic and reached alarmingly new heights during the pandemic.</p><p><strong>Objective: </strong>Evaluate whether hospital nurses' job outcomes and evaluations of patient safety, quality of care, and hospital management responsiveness have returned at least to prepandemic levels.</p><p><strong>Design: </strong>Cross-sectional study of survey data from 50,044 nurses in New York and Illinois hospitals: prepandemic (December 2019-February 2020), during (April 2021-June 2021), and postpandemic (December 2023-March 2024).</p><p><strong>Measures: </strong>Nurse outcomes (ie, high burnout, job dissatisfaction, intention to leave employer). Hospital nursing resources (eg, unfavorable work environment, nurse staffing ratio). Hospital management responsiveness (eg, nurses' confidence in management to resolve clinical care problems).</p><p><strong>Results: </strong>Nurses' job dissatisfaction and intentions to leave their hospital employer rose significantly over time, with the highest percentages postpandemic-32.2% of nurses reporting job dissatisfaction and 27.4% intending to leave. Percentages of nurses with high burnout have remained high before (48.0%), during (51.0%), and after (48.5%) the pandemic. Nurses' evaluations of their working conditions are at their worst postpandemic: 49.2% reported unfavorable work environments, 61.5% reported not enough staff, and objective measures of staffing ratios on medical-surgical units were 6.0 patients-to-nurse, up from 5.7 prepandemic. Evaluations of patient safety, quality of care, and management responsiveness were significantly worse postpandemic.</p><p><strong>Conclusions: </strong>Job dissatisfaction and intentions to leave employment continue to rise even after the pandemic has receded, and more nurses lack confidence in their management to act in the best interest of patients. New policy approaches seem warranted, including setting minimum safe hospital nurse staffing requirements.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"293-297"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Telemental Health Care by Adults in the United States.","authors":"Mark Olfson, Chandler McClellan, Samuel H Zuvekas, Carlos Blanco","doi":"10.1097/MLR.0000000000002290","DOIUrl":"10.1097/MLR.0000000000002290","url":null,"abstract":"<p><strong>Background: </strong>Although the recent proliferation of telemental health care has transformed delivery of outpatient mental health care for many patients, little is known about population-level access to telehealth, hybrid, and in-person outpatient mental health care in the US.</p><p><strong>Objectives: </strong>The objective of this report is to characterize patterns of all telehealth, hybrid, and all in-person outpatient mental health care by US adults.</p><p><strong>Methods: </strong>An analysis is presented of 2021-2022 Medical Expenditure Panel Survey data (n=39,561) focusing on annual percentages of adults receiving all telehealth, hybrid, and all in-person outpatient mental health care. Results are presented overall and stratified by sociodemographic characteristics. Differences are reported in average marginal estimates from logistic regressions for each sociodemographic characteristic controlling for age group, sex, and psychological distress (Kessler-6).</p><p><strong>Results: </strong>Approximately 12.0% of adults annually received outpatient mental health care, including 3.3% all telemental health care, 2.6% hybrid, and 6.1% all in-person mental health care. After controlling for age, sex, and distress, unemployed adults 65 years of age or younger were less likely than employed adults to receive all mental health care (-1.0 percentage points, 95% CI: -1.6 to -0.4), and uninsured individuals were less likely than those with private insurance (-2.8 percentage points, 95% CI: -3.6 to -1.9). By contrast, college graduates were 3.2 percentage points (95% CI: 2.3-4.0) more likely than those with less than a high school diploma, higher-income individuals were 1.6 percentage points (95% CI: 0.8-2.30) more likely than those below the poverty level, and urban residents were 1.9 percentage points (95% CI: 1.1-2.7) more likely than rural residents to receive all telemental health care.</p><p><strong>Conclusions: </strong>These national patterns highlight differences in US telemental health care access across employment, education, income, insurance, and geographic groups.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"64 4","pages":"216-220"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing Cluster Randomized Trials: A Practical Guide for Investigators.","authors":"Kendra Davis-Plourde, Xiaoying Yu, Jeanne A Teresi","doi":"10.1097/MLR.0000000000002283","DOIUrl":"10.1097/MLR.0000000000002283","url":null,"abstract":"<p><strong>Background: </strong>An important consideration in the design stage of randomized controlled trials is whether individuals within each site should or can be randomized to study arms (an individually randomized controlled trial) or whether entire sites should be randomized (a cluster randomized trial) where the clusters are sites. Recently, cluster randomized trials have grown in popularity; however, investigators have expressed a need for guidelines related to selection of the best design-especially when considering more complex designs such as stepped wedge. This commentary attempts to provide such guidance.</p><p><strong>Methods: </strong>In this commentary, we address common misconceptions surrounding the appropriate use of cluster randomization and crossover designs (such as the stepped wedge design). The intracluster correlation coefficients for different levels of clustering are presented, and the impact of different designs on sample size discussed. We provide practical recommendations that are accessible to investigators from all disciplines, regardless of their level of statistical training. On the basis of these recommendations, we present a flowchart to help researchers identify a suitable trial design for their study. In addition, we provide a table of commonly used statistical definitions related to cluster randomized trials and a table of design considerations for more complex designs to support effective consultation with a statistician during the design phase.</p><p><strong>Conclusion: </strong>On the basis of these guidelines, it is recommended that researchers prioritize the use of individual randomization and a parallel trial design when the goal of the study is to assess the efficacy or effectiveness of an intervention.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"179-191"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personal Health Goals in Homeless-Experienced Veterans: Rates, Patterns, and Associations With Health-Related Needs.","authors":"Mariana Ward, Kathryn S Macia, Paige Shaffer, Justeen Hyde, David Smelson, Daniel M Blonigen","doi":"10.1097/MLR.0000000000002291","DOIUrl":"10.1097/MLR.0000000000002291","url":null,"abstract":"<p><strong>Objective: </strong>To advance patient-centered care for high-need homeless-experienced patients, we identified the rates of various personal health goals, the broader domains that underlie these goals, and associations between these domains and the health-related needs of this population.</p><p><strong>Method: </strong>The sample consisted of 176 veterans from 3 VA Medical Centers who were enrolled in primary care, on VA's Homeless Registry, and high utilizers of acute care. An interview was conducted with each participant to collect information on their personal health goals and health-related needs. Exploratory factor analysis was used to identify broad domains underlying endorsement of personal health goals. Associations between these broad goal domains and health-related needs (substance use, mental and physical health, treatment engagement, and psychosocial) were examined using an exploratory structural equation modeling-within-confirmatory factor analysis approach.</p><p><strong>Results: </strong>Three broad domains were found to underlie the personal health goals of the sample: social functioning, health promotion, and substance use. Social functioning and health promotion were highly correlated, whereas substance use was weakly correlated with both social functioning and health promotion. All substance use-related needs were positively associated with substance use goals. Mental and physical health needs were primarily associated with health promotion goals. Treatment engagement and psychosocial needs demonstrated associations across all 3 goal domains.</p><p><strong>Conclusions: </strong>Findings highlight the high value that many high-need homeless-experienced patients place on their social well-being and the potential benefits to measuring both deficiency and growth needs in this population. Clinical implications and future directions for research are discussed.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"230-238"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychiatric Medication Prescribing by Nurse Practitioners and Physician Associates for Medicare Beneficiaries.","authors":"Roderick S Hooker, G Martin Reinhart, Joycelyn M Yamzon, Robert E McKenna","doi":"10.1097/MLR.0000000000002293","DOIUrl":"10.1097/MLR.0000000000002293","url":null,"abstract":"<p><strong>Background: </strong>There is a significant shortage of psychiatrists compared with the demand for their services. We studied Medicare Part D claims of psychiatrists and similar clinician prescribers to identify possible shifts in medication prescribing to address this gap.</p><p><strong>Objective: </strong>This pharmacoepidemiology study aimed to identify prescribing patterns among psychiatrists, family physicians, internists, physician associates/assistants (PAs), and nurse practitioners (NPs), as well as trends.</p><p><strong>Design: </strong>An observational, retrospective cohort study of Medicare Part D claims from 2013 to 2022 was conducted. Psychiatrists' prescription patterns were compared with those of non-psychiatrists, using the National Provider Identifier (NPI). Diagnosis information was not available in the dataset.</p><p><strong>Participants: </strong>In 2022, more than 32,400 psychiatrists' prescriptions were submitted for more than 36.6 million Medicare Part D claims for various medications.</p><p><strong>Main measures: </strong>Prescribers and medication claim counts were analyzed to determine the most commonly prescribed drugs by psychiatrists. Total psychiatrist prescription counts and trends were compared with those of primary care physicians, PAs, and NPs.</p><p><strong>Key results: </strong>Family practice physicians wrote more than 55 million prescriptions in 2022, nearly twice the number written by psychiatrists. From 2013 to 2022, prescriptions written by PAs and NPs showed a strong upward trend. In 2020, prescription claims by NPs surpassed psychiatrists, and by 2022, they had exceeded those of internal medicine physicians.</p><p><strong>Conclusions: </strong>Claims by NPs increased from 8.6% to 24.8%, whereas psychiatrists' claims decreased from 24.4% to 18.0%. As of 2023, NPs and PAs comprise a significant portion of the workforce that addresses gaps in mental health medication care for Medicare patients.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"249-256"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}