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. 2022 Jun 25;22(1):522.
doi: 10.1186/s12877-022-03176-3.

Prescribing Alzheimer's Disease treatments by provider type and geographic region: a comparison among physicians, nurse practitioners, and physician assistants

Jenny Y Park  1   2 , David L Veenstra  3 , Christopher J Wallick  4 , Zachary A Marcum  3
Affiliations

Prescribing Alzheimer's Disease treatments by provider type and geographic region: a comparison among physicians, nurse practitioners, and physician assistants

Jenny Y Park et al. BMC Geriatr. .

Abstract

Background: The estimated increase in Alzheimer's Disease (AD) caseload may present a logistical challenge to the US healthcare system. While nurse practitioners (NPs) and physician assistants (PAs) are increasingly delivering primary care to patients with chronic diseases, the nature of their prescribing of AD medications is largely unknown. The primary objective of this study was to compare the prescribing of AD medications across provider types (physician, NP, and PA) and geographic regions.

Methods: We conducted a retrospective cohort study using IBM MarketScan® commercial and Medicare supplemental claims to examine unique AD prescriptions prescribed between January 1, 2016, and December 31, 2019. Parallel analysis of prescriptions for another geriatric condition, osteoporosis (OP), was also conducted for comparison.

Results: A total of 103,067 AD prescriptions and 131,773 OP prescriptions were included in analyses. Physicians prescribed most AD prescriptions (95.65%), followed by NPs (3.37%) and PAs (0.98%). Small differences were identified among individual AD medications prescribed by physicians compared to NP/PAs. NPs/PAs prescribed a significantly higher proportion of AD prescriptions in rural as compared to urban areas (z = 0.023, 95%CI [0.018, 0.028]).

Conclusion: Minimal variation exists in AD prescribing among physicians, NPs, and PAs, but NPs/PAs prescribe more AD prescriptions in rural areas. NPs/PAs, especially in rural areas, may play critical roles in alleviating projected workforce constraints. Further research assessing AD care, health outcomes, and costs by provider type and region is necessary to better guide healthcare workforce planning for AD care.

Keywords: Alzheimer’s Disease; Dementia; Geographic disparities; Prescribing patterns; Provider type; Rural; Urban.

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Conflict of interest statement

JY Park is a Postdoctoral Fellow in Health Economics and Outcomes Research (HEOR) with Genentech and the University of Washington Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute.

CJ Wallick is a full-time employee of Genentech.

DL Veenstra has served as a consultant to Genentech.

Figures

Fig. 1
Fig. 1
Cohort selection flowchart. Abbreviations: AD = Alzheimer’s Dementia, OP = Osteoporosis, ID = Identification, MSA = Metropolitan Statistical Area
Fig. 2
Fig. 2
Proportions of AD and OP medicines prescribed by NPs, PAs, and Physicians. Abbreviations: AD = Alzheimer’s Dementia, OP = Osteoporosis, NP = Nurse Practitioner, PA = Physician Assistant
Fig. 3
Fig. 3
The distribution of prescriptions and proportion of prescriptions written by non-physician PCPs (NPs/PAs) or specialist physicians by rurality. Abbreviations: PCP = Primary Care Provider, NP = Nurse Practitioner, PA = Physician Assistants, MD = Medical Doctor. The Non-Metro category incluedes rural and micropolitan counties
Fig. 4
Fig. 4
Heat maps depicting the proportion of prescriptions prescribed by specialist physicians in each county
See this image and copyright information in PMC

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