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：
8451415
负责人：
JULIE Marie DONOHUE
金额：
$ 50.76万
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 2015-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8451415
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）：抗精神病药物是 2009 年最畅销的药物类别，也是近期州医疗补助药品支出增长的主要驱动力，自几种非典型抗精神病药物推出以来，抗精神病药物的使用在过去二十年中发生了巨大变化。最近，美国食品和药物管理局 (FDA) 的警告和比较有效性研究指出，使用非典型药物会带来较高的风险，并对其成本效益提出质疑。人们对精神科医生如何采用新药物，或者当有关精神药物疗效和/或安全性的新证据出现时，他们是否以及如何改变其实践模式知之甚少。重要的是，我们对促进或抑制精神科医生对新的安全性和有效性信息做出反应的提供者、组织和政策层面的因素知之甚少。使用 IMS Health 为所有开出抗精神病药物的精神病医生提供的独特的医生级抗精神病药物处方数据，这些数据与 AMA 主文件中的医生特征、医疗保健组织服务数据中的医生与医疗保健组织的关系、药品制造商促销活动的数据相关联，关于当地环境特征的数据，以及关于 1997-2011 年期间抗精神病药物覆盖率的州医疗补助和医疗保险政策的数据，我们将： 1)描述精神科医生采用新抗精神病药物的速度，并确定与早期与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性信息的反应，并确定与精神科医生的反应相关的因素； 3）评估商业影响（例如制造商促销）和政策因素（例如医疗补助和医疗保险药物承保范围限制）是否影响精神科医生对药物信息的反应。解决对精神障碍患者精神药理学护理质量和效率的担忧取决于改变个体医生的行为。然而，我们不知道何时以及如何进行针对性干预，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由他们接受培训的地点和时间来解释的，那么应该加强改善精神药理学和循证医学方面的精神科住院医师培训的努力。或者，如果组织因素、药品促销和/或政策因素解释了处方行为的大部分变化，那么这些发现将激发组织和政策层面的干预措施。。