Antipsychotic Medication for Older Individuals

use Medicare Part D data to describe the temporal patterns from 2013 to 2023 in the use of antipsychotic medications, with a focus on the discipline of the clinician listed on the prescription.They show that the share of such prescriptions issued by psychiatrists decreased from 48.4% in 2013 to 32.4% in 2023 and that the share by primary care physicians (PCPs) decreased from 33.0% to 23.8%.In contrast, the share of antipsychotic prescriptions written by advanced practice registered nurses (APRNs) or physician assistants (PAs) increased from 13.8% in 2013 to 39.6% in 2023.Overall, the mean number of prescriptions for antipsychotics per Medicare Part D enrollee decreased from 0.63 in 2013 to 0.46 in 2023.The authors concluded that there has been a large shift in who prescribes antipsychotic drugs, with fewer prescriptions from psychiatrists and PCPs and more from APRNs and PAs.They suggest that greater attention be paid to ensuring that APRNs and PAs are educated and supervised in the appropriate prescribing of these drugs.In discussing this study, I want to make 2 important but not closely related points.The first is that the particular limitations of the data sources used in this study substantially limit the conclusions that can be drawn from the findings.The second point has to do with the more general question of how antipsychotic drug prescribing for older individuals should be viewed.The major limitation of the data sources is that there is no information about the Medicare Part D enrollees who received the prescriptions, such as their age, race and ethnicity, diagnoses, reason for the prescription, and whether they live in the community or a nursing home.There is also little information about the prescription itself, such as days' supply, whether it was prescribed for a short period or longer duration, and whether it was to be taken only as needed or daily.