title: Aligning clinical practice to PTSD treatment guidelines: medication prescribing by provider type.
abstract: OBJECTIVE
  Veterans with posttraumatic stress disorder (PTSD) are frequently prescribed psychiatric medications that are currently not supported by a guideline developed by the U.S. Department of Veterans Affairs and the U.S. Department of Defense. To better understand this practice, this study examined prescribing frequencies for three classes of psychiatric medications and the proportion of prescribing attributable to various provider types.
  
  
  METHODS
  This cross-sectional study analyzed fiscal year 2009 electronic pharmacy data from the Veterans Health Administration (VHA) for 356,958 veterans with PTSD who were receiving medications from VHA prescribers. Veterans had at least one VHA encounter with a diagnostic code of PTSD and evidence of continuous medication use. Medications of interest were selective serotonin-norepinephrine reuptake inhibitors (SSRI/SNRIs), second-generation antipsychotic medications, and benzodiazepines. Analyses described the proportion of prescribing attributable to mental health care providers and primary care providers for each medication class.
  
  
  RESULTS
  In 2009, among all veterans with PTSD who had continuous VA medication use, 65.7% were prescribed SSRI/SNRIs, and 70.2% of this prescribing was attributable to mental health care providers. Second-generation antipsychotics were prescribed for 25.6% of these veterans, and 80.2% of the prescribing was attributable to mental health care providers. Benzodiazepines were prescribed for 37.0% of the sample, and 68.8% of the prescribing was attributable to mental health care providers.
  
  
  CONCLUSIONS
  The findings indicate that veterans with PTSD were frequently prescribed medications not supported by existing guidelines. Most of these prescriptions were written by mental health care providers. Interventions to align prescribing with PTSD treatment guidelines should emphasize provider type.
authors.affiliation: Center for Comprehensive Access andDelivery Research and Evaluation, Iowa City Veterans Affairs (VA) Health Care System, University of Iowa, Iowa City, IA 52246, USA. thad-abrams@uiowa.edu
authors.forename: Thad E
authors.initials: TE
authors.lastname: Abrams
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lund
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Bernardy
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Friedman
mesh_terms: D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000145:classification / Q000627:therapeutic use*; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology; D058014:Veterans Health / Q000706:statistics & numerical data*
chemical_list: D011619:Psychotropic Drugs