A Quantitative Descriptive Study Using the Theoretical Domains Framework to Investigate and Compare the Psychotropic Medication Prescribing Behavior of Primary Care Prescribers

摘要

Psychotropic medications rank among the most widely prescribed, largest-selling, and fastest-growing classes of drugs in the U.S. today. Largely attributed to the role of primary care providers in mental health care and the use of psychotropic medications for non-psychiatric conditions, the prevalence of psychotropic medication prescribing is a problem due to side effects, drug-to-drug interactions, and withdrawal effects. Previous research has not reliably explained why practitioners vary in prescribing behavior. This non-experimental cross-sectional quantitative research investigation compared the psychotropic medication prescribing behavior of primary care prescribers from the perspective of the theoretical domains framework (TDF), a validated theoretical framework for identifying factors influencing clinical behavior. The inquiry was guided by four research questions that explored prescribing behavior between primary care physicians (MDs, DOs), physician assistants (PAs), and nurse practitioners (NPs), between high and low prescribers, among high prescribers, and among low prescribers. The Determinants of Implementation Behavior Questionnaire: Psychotropic Medication Prescribing Behavior (DIBQ: PMPB), a unique psychotropic medication prescribing behavior version of the TDF-based Determinants of Implementation Behavior Questionnaire (DIBQ) template was administered to 49 Pennsylvania primary care MDs, DOs, PAs, and NPs. Due to low sample size, the groups were aggregated and compared between MDs/DOs and PAs/NPs. Data were analyzed with the non-parametric Kruskal-Wallis H test. Results revealed that mean ranks were significantly different only among low prescribers in which MDs/DOs were significantly higher than PAs/NPs in Socio-political context and Innovation strategy. However, PAs/NPs were higher than MDs/DOs in Social/professional role and identity and Intentions. Findings suggest that differences may be related to division of labor, primary care setting, and age and gender of provider. MDs/DOs may focus more on protocol, organization, and practice-based aspects of running a business, whereas PAs/NPs may have a holistic mindset that is more flexible, accommodating, and sensitive to the patient. These factors should be thoroughly investigated in randomized controlled trials to more fully understand a provider's motivation and pattern for prescribing psychotropic medications, particularly in situations where safer evidence-based treatments exist.