Prescribing of Alzheimer’s Disease Treatments by Provider Type and Geographic Region: A Comparison among Physicians, Nurse Practitioners, and Physician Assistants

Thesis (Master's)--University of Washington, 2021Background: The U.S. healthcare workforce is insufficient to handle the increasing Alzheimer’s Dementia (AD) caseload. 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 treatments is largely unknown.Objective: The primary objective of this study was to compare the prescribing of AD medicines 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. Food and Drug Administration (FDA) indicated AD prescriptions were identified and prescribing patterns were descriptively analyzed by provider type and metropolitan statistical area (MSA). 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 our analyses. Physicians, NPs, and PAs prescribed 95.65%, 3.37%, and 0.98% of AD prescriptions, respectively. NPs and PAs prescribed a significantly higher (95% CI: 0.018, 0.028) proportion of AD prescriptions in rural (5.84%) as compared to urban areas (3.56%). A significantly higher proportion of AD prescriptions were prescribed by NPs and PAs (95% CI: 0.004, 0.008) and specialists (95% CI: 0.185, 0.191) compared to OP prescriptions. Conclusion: The proportion of AD prescriptions prescribed by NPs and PAs is relatively low, especially in urban areas. Further research assessing AD health outcomes and costs by provider type and geographic region is necessary to better guide healthcare workforce planning for patients with AD