Similarities and differences in the prescribing patterns of psychiatric advanced practice registered nurses and psychiatrists in a community mental health center

During a 12 month period (January 1 to December 31, 2000), 422,438 service contacts were recorded for 7,251 adult patients at a large community mental health center. Of the total number of adults served, 5,507 (76%) had medication-related contacts with an APRN (n = 1,384) or a psychiatrist (n < = 2,974), or both APRNs and psychiatrists (n = 654). APRNs and psychiatrists treated clients who were similar in age, gender, marital status, level of education and ethnicity, and with similar Axis I and Axis II diagnoses. Differences in client characteristics and diagnoses were generally attributed to the staffing patterns of specialty clinics and to the assignment of certain clients to psychiatrists for evaluation for stimulant medications. A review of 120 patient charts revealed that, overall, APRNs and psychiatrists prescribed similar numbers of medications. Psychiatrists prescribed more types of antidepressant medications, and they prescribed more than twice the number of benzodiazapines. APRNs prescribed more SSRI antidepressants and may have preferentially used this class of medications to treat anxiety. APRNs spent significantly more time with clients during medication visits. In semistructured interviews both APRNs and psychiatrists described many similarities in prescribing practices. They identified themselves as coming from a medical background, but with differing and complementary focuses. The need for balance in the clinic staffing of APRNs and psychiatrists was emphasized by both groups of professionals.