Assessing the safety and efficacy of prescribing psychologists in New Mexico and Louisiana.

This study aimed to compare patient outcomes between prescribing psychologists, psychiatrists, and primary care physicians (PCPs). Private insurance claims (2005-2021; n = 307,478) were used to conduct an active comparator, new user longitudinal cohort study developed using target trial emulation. Inverse propensity for treatment weighting was used to adjust for baseline differences in a range of sociodemographic, clinical, and contextual patient factors. Differences in the 1-year rate of health care visits for adverse drug events (ADEs), psychiatric emergency department (ED) utilization, medication adherence, and psychotropic polypharmacy were identified between prescribing psychologists and the other provider types using doubly robust Cox proportional hazards models. Compared to patients of psychiatrists, patients of prescribing psychologists had a 24% lower rate of ADEs (95% CI [0.60, 0.96]), a 20% lower rate of psychotropic polypharmacy (95% CI [0.74, 0.86]), and similar rates of psychiatric ED utilization and medication nonadherence. Compared to patients of PCPs, patients of prescribing psychologists had 138% higher rates of psychiatric ED utilization (95% CI [1.67, 3.39]), 175% higher rates of psychotropic polypharmacy (95% CI [2.53, 2.99]), 28% lower rates of medication nonadherence (95% CI [0.66, 0.78]), and similar rates of ADEs. Using robust pharmacoepidemiological methods, we noted that among mental health specialists, prescribing psychologists appear to be as safe and efficacious as psychiatrists in a large sample of privately insured patients. Notable differences in safety and efficacy when compared to PCPs may be attributable to differences between specialty and primary care. Future research on prescribing psychologists should move toward studies of care quality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia.

OBJECTIVE: This study examined whether informal caregiver psychologic distress decreases the likelihood of influenza vaccination for community-dwelling elderly with dementia. A secondary aim was to determine whether psychologic distress mediates the relationship between other predisposing, enabling, and medical need variables and vaccination. METHODS: Data were drawn from the 1998 National Longitudinal Caregiver Survey. The final sample consisted of 1406 community-dwelling male veterans with dementia and their coresiding female informal caregivers. Presence of caregiver psychologic distress was measured using the Boston Short Form of the Center for Epidemiologic Studies Depression Scale. Vaccination was identified by examining Veteran Administration Outpatient Data Files for visits indicating influenza vaccine administration during the 1998 influenza vaccine season (September 1 to December 31). Multivariate path analysis with observed variables was used to estimate direct and indirect probit path coefficients between independent variables, caregiver psychologic distress, and veteran vaccination. RESULTS: As hypothesized, caregiver distress was significantly associated with a decreased likelihood of care-recipient vaccination (unstandardized coefficient [b] = -0.023, P < 0.01). Adjusted for other variables, the predicted probability of vaccination was 37.7% for care-recipients with nondistressed caregivers compared with 29.4% for care-recipients with distressed caregivers. Furthermore, a number of factors significantly influenced vaccination via their influence on psychologic distress. CONCLUSION: We conclude that caregiver psychologic distress may interfere with access to influenza vaccination in persons with dementia. Access to vaccination may be improved directly by detecting and treating emotional health problems in caregivers and indirectly by addressing precursors to caregiver distress.

Medication use among black and white caregivers of older male veterans with dementia.

BACKGROUND: Few studies have examined racial differences in medication use among informal caregivers of elderly individuals with progressive dementia. It is important to identify racial disparities in medication use so that these differences can be corrected. OBJECTIVE: The purpose of the current study was (1) to evaluate whether black caregivers were less likely to be taking medication than white caregivers after controlling for specific factors and (2) to examine the relationship between caregiver race and other predisposing, enabling, and need factors, and the use of specific categories of medications. METHODS: A secondary analysis of data was conducted from a national survey of 2032 black and white female caregivers of elderly male US veterans with a diagnosis of Alzheimer's disease or vascular dementia. Caregiver use of specific medications was classified according to the Veterans Affairs medication classification system. The Andersen Behavioral Model of Health Services Use provided a framework for multivariate models predicting racial differences in any medication use and use of specific categories of medications. RESULTS: Black caregivers were significantly less likely to use any medication than white caregivers (adjusted odds ratio [OR]=0.42; 95% CI=0.31-0.57). These differences persisted even after controlling for other predisposing, enabling, and need factors, and for outpatient doctor visits. Black caregivers were significantly less likely than white caregivers to be taking endocrine/metabolic medications (adjusted OR=0.57; 95% CI=0.42-0.77) and central nervous system medications (adjusted OR=0.57; 95% CI=0.39-0.83). CONCLUSION: The results of this analysis suggest that significant racial differences in medication use exist among informal caregivers providing care for elderly male US veterans with progressive dementia.