Influences on Psychiatrist Prescribing of Antipsychotics

对精神科医生开抗精神病药处方的影响

基本信息

批准号：
8605927
负责人：
JULIE Marie DONOHUE
金额：
$ 48.36万
依托单位：
HARVARD MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-01 至 2016-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8605927
关键词：
Accounting Address Adopted Adoption Antipsychotic Agents Behavior Caring Characteristics Clinical Communities Consensus County Data Drug Prescriptions Economics Effectiveness Elderly Evidence Based Medicine Expenditure Exposure to Government Financing Growth Health Heterogeneity Hospitals Income Individual Intervention Link Manufacturer Name Marketing Masks Medicaid Medicare Medicare/Medicaid Mental disorders Mood Disorders New Agents Organizational Affiliation Organizational Policy Patients Pattern Pharmaceutical Preparations Pharmacologic Substance Pharmacy facility Physicians Policies Policy Maker Population Provider Psychiatrist Psychopharmacology Residencies Risk Safety Sales Sampling Schizophrenia Speed Training Training and Education United States Food and Drug Administration Variant Visit atypical antipsychotic behavior change clinical practice comparative effectiveness cost effectiveness demographics drug efficacy effectiveness research health care service organization improved olanzapine prior authorization programs psychopharmacologic response trend

项目摘要

DESCRIPTION (provided by applicant): Use of antipsychotic medications, the top selling medication class in 2009 and a primary driver of recent growth in state Medicaid pharmacy expenditure, has changed dramatically in the past two decades since the introduction of several atypical antipsychotics. Recently, Food and Drug Administration (FDA) warnings and comparative effectiveness research have pointed to elevated risks associated with use of atypicals and have raised questions about their cost-effectiveness. Little is known about how psychiatrists adopt new medications, or whether and how they change their practice patterns when new evidence emerges on psychiatric drug efficacy and/or safety. Importantly, we know little about the provider-, organizational- and policy-level factors that promote or inhibit psychiatrists' response to new safety and efficacy information. Using unique physician-level data on antipsychotic prescribing for all psychiatrists who prescribe antipsychotic medications from IMS Health linked with physician characteristics from the AMA Masterfile, physician affiliations with health care organizations from the Health Care Organization Services data, data on pharmaceutical manufacturers' promotional efforts, data on local environmental characteristics, and data on state Medicaid and Medicare policies on coverage of antipsychotics for the period 1997-2011, we will: 1) characterize the speed of adoption of new antipsychotic medications among psychiatrists and identify factors associated with early vs. late adoption; 2) examine psychiatrists' responses to comparative effectiveness research and safety information and identify factors associated with a psychiatrist's response; and 3) evaluate whether commercial influences (e.g., manufacturer promotion) and policy factors, such as Medicaid and Medicare drug coverage restrictions, influence psychiatrists' responses to drug information. Addressing concerns about the quality and efficiency of psychopharmacologic care for people with mental disorders depends on changing the behavior of individual physicians. However, we do not know when and how to target interventions nor which interventions are most effective. Should we find that much of the variation in psychiatrists' prescribing is explained by where and when they trained then efforts to improve psychiatric residency training in psychopharmacology and evidence-based medicine should be intensified. Alternatively, if organizational factors, pharmaceutical promotion and/or policy factors explain much of the variation in prescribing behaviors, such findings would motivate interventions at the organizational and policy-level. .

描述（由申请人提供）：使用抗精神病药，2009年销售药物班的最高销售药物以及最近二十年以来，在过去的二十年中，州医疗补助药房支出近期增长的主要驱动力已经发生了巨大变化。最近，食品和药物管理局（FDA）警告和比较有效性研究表明，与使用非典型人有关的风险升高，并提出了有关其成本效益的问题。关于精神科医生如何采用新药物，或者当新的有关精神病药物疗效和/或安全性的新证据时，他们是否以及如何改变其实践模式。重要的是，我们对促进或抑制精神科医生对新安全和效力信息的反应的提供商，组织和政策级别的因素知之甚少。使用独特的医生级别数据，以针对所有精神病医生的抗精神病药处方，这些精神病医生从IMS健康中开出抗精神病药物，与AMA Masterfile的医师特征联系起来，医疗保健组织与医疗保健组织服务的医疗保健组织的隶属关系有关在1997 - 2011年期间，我们将：1）表征精神科医生中新抗精神病药的采用速度，并确定与早期和晚期采用相关的因素； 2）检查精神科医生对比较有效性研究和安全信息的反应，并确定与精神科医生的反应相关的因素； 3）评估商业影响（例如制造商的促进）和政策因素（例如医疗补助和医疗保险药物覆盖范围限制）是否会影响精神科医生对药物信息的反应。解决对精神障碍患者心理药物护理质量和效率的担忧取决于改变个人医生的行为。但是，我们不知道何时以及如何靶向干预措施，也不知道哪些干预措施最有效。如果我们发现精神科医生处方的大部分差异是通过训练的何处和何时训练来解释的，那么应该加强改善心理药理学和循证医学精神病居住训练的努力。另外，如果组织因素，药物促进和/或政策因素解释了处方行为的大部分差异，那么这些发现将激发组织和政策级别的干预措施。。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Antipsychotic prescribing: do conflict of interest policies make a difference?

DOI：
10.1097/mlr.0000000000000329
发表时间：
2015-04
期刊：
Medical care
影响因子：
3
作者：
Anderson TS;Huskamp HA;Epstein AJ;Barry CL;Men A;Berndt ER;Horvitz-Lennon M;Normand SL;Donohue JM
通讯作者：
Donohue JM

A Bayesian hierarchical model for characterizing the diffusion of new antipsychotic drugs.

DOI：
10.1111/biom.13324
发表时间：
2021-06
期刊：
Biometrics
影响因子：
1.9
作者：
Gu C;Huskamp H;Donohue J;Normand SL
通讯作者：
Normand SL

Regional Variation in Physician Adoption of Antipsychotics: Impact on US Medicare Expenditures.

医生采用抗精神病药物的地区差异：对美国医疗保险支出的影响。

DOI：
发表时间：
2016
期刊：
The journal of mental health policy and economics
影响因子：
0
作者：
Donohue,JulieM;Normand,Sharon-LiseT;Horvitz-Lennon,Marcela;Men,Aiju;Berndt,ErnstR;Huskamp,HaidenA
通讯作者：
Huskamp,HaidenA

Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior.

患者、医生和组织对抗精神病药物处方行为变化的影响。

DOI：
发表时间：
2016
期刊：
The journal of mental health policy and economics
影响因子：
0
作者：
Tang,Yan;Chang,Chung-ChouH;Lave,JudithR;Gellad,WalidF;Huskamp,HaidenA;Donohue,JulieM
通讯作者：
Donohue,JulieM