Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007
Objective Physician antipsychotic prescribing behavior may be influenced by comparative effectiveness evidence, regulatory warnings, and formulary and other restrictions on these drugs. This study measured changes in the degree to which physicians are able to customize treatment choices and changes...
| Main Authors: | , , , , , |
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| Other Authors: | |
| Format: | Article |
| Language: | en_US |
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American Psychiatric Publishing
2015
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| Online Access: | http://hdl.handle.net/1721.1/98494 https://orcid.org/0000-0002-6388-0768 |
| _version_ | 1826207411676905472 |
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| author | Donohue, Julie O'Malley, A. James Horvitz-Lennon, Marcela Taub, Anna Levine Berndt, Ernst R. Huskamp, Haiden A. |
| author2 | Sloan School of Management |
| author_facet | Sloan School of Management Donohue, Julie O'Malley, A. James Horvitz-Lennon, Marcela Taub, Anna Levine Berndt, Ernst R. Huskamp, Haiden A. |
| author_sort | Donohue, Julie |
| collection | MIT |
| description | Objective
Physician antipsychotic prescribing behavior may be influenced by comparative effectiveness evidence, regulatory warnings, and formulary and other restrictions on these drugs. This study measured changes in the degree to which physicians are able to customize treatment choices and changes in physician preferences for specific agents after these events.
Methods
The study used 2002–2007 prescribing data from the IMS Health Xponent database and data on physician characteristics from the American Medical Association for a longitudinal cohort of 7,399 physicians. Descriptive and multivariable regression analyses were conducted of the concentration of prescribing (physician-level Herfindahl index) and preferences for and likelihood of prescribing two first-generation antipsychotics and six second-generation antipsychotics. Analyses adjusted for prescribing volume, specialty, demographic characteristics, practice setting, and education.
Results
Antipsychotic prescribing was highly concentrated at the physician level, with a mean unadjusted Herfindahl index of .33 in 2002 and .29 in 2007. Psychiatrists reduced the concentration of their prescribing more over time than did other physicians. High-volume psychiatrists had a Herfindahl index that was half that of low-volume physicians in other specialties (.18 versus .36), a difference that remained significant (p<.001) after adjustment for physician characteristics. The share of physicians preferring olanzapine dropped from 29.9% in 2002 to 10.3% in 2007 (p<.001) while the share favoring quetiapine increased from 9.4% to 44.5% (p<.001). Few physicians (<5%) preferred a first-generation antipsychotic in 2002 or 2007.
Conclusions
Preferences for specific antipsychotics changed dramatically during this period. Although physician prescribing remained heavily concentrated, the concentration decreased over time, particularly among psychiatrists. |
| first_indexed | 2024-09-23T13:49:15Z |
| format | Article |
| id | mit-1721.1/98494 |
| institution | Massachusetts Institute of Technology |
| language | en_US |
| last_indexed | 2024-09-23T13:49:15Z |
| publishDate | 2015 |
| publisher | American Psychiatric Publishing |
| record_format | dspace |
| spelling | mit-1721.1/984942022-10-01T17:19:15Z Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007 Donohue, Julie O'Malley, A. James Horvitz-Lennon, Marcela Taub, Anna Levine Berndt, Ernst R. Huskamp, Haiden A. Sloan School of Management Berndt, Ernst R. Objective Physician antipsychotic prescribing behavior may be influenced by comparative effectiveness evidence, regulatory warnings, and formulary and other restrictions on these drugs. This study measured changes in the degree to which physicians are able to customize treatment choices and changes in physician preferences for specific agents after these events. Methods The study used 2002–2007 prescribing data from the IMS Health Xponent database and data on physician characteristics from the American Medical Association for a longitudinal cohort of 7,399 physicians. Descriptive and multivariable regression analyses were conducted of the concentration of prescribing (physician-level Herfindahl index) and preferences for and likelihood of prescribing two first-generation antipsychotics and six second-generation antipsychotics. Analyses adjusted for prescribing volume, specialty, demographic characteristics, practice setting, and education. Results Antipsychotic prescribing was highly concentrated at the physician level, with a mean unadjusted Herfindahl index of .33 in 2002 and .29 in 2007. Psychiatrists reduced the concentration of their prescribing more over time than did other physicians. High-volume psychiatrists had a Herfindahl index that was half that of low-volume physicians in other specialties (.18 versus .36), a difference that remained significant (p<.001) after adjustment for physician characteristics. The share of physicians preferring olanzapine dropped from 29.9% in 2002 to 10.3% in 2007 (p<.001) while the share favoring quetiapine increased from 9.4% to 44.5% (p<.001). Few physicians (<5%) preferred a first-generation antipsychotic in 2002 or 2007. Conclusions Preferences for specific antipsychotics changed dramatically during this period. Although physician prescribing remained heavily concentrated, the concentration decreased over time, particularly among psychiatrists. National Institute of Mental Health (U.S.) (Grant R01MH093359) National Institute of Mental Health (U.S.) (Grant P30 MH090333) National Institute of Mental Health (U.S.) (Grant R01MH087488) Agency for Healthcare Research and Quality (Grant R01HS017695) Robert Wood Johnson Foundation (Investigator Award in Health Policy Research) 2015-09-15T14:20:04Z 2015-09-15T14:20:04Z 2014-03 Article http://purl.org/eprint/type/JournalArticle 1075-2730 1557-9700 http://hdl.handle.net/1721.1/98494 Donohue, Julie, A. James O’Malley, Marcela Horvitz-Lennon, Anna Levine Taub, Ernst R. Berndt, and Haiden A. Huskamp. “Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007.” Psychiatric Services 65, no. 3 (March 2014): 315–322. https://orcid.org/0000-0002-6388-0768 en_US http://dx.doi.org/10.1176/appi.ps.201200536 Psychiatric Services Creative Commons Attribution-Noncommercial-Share Alike http://creativecommons.org/licenses/by-nc-sa/4.0/ application/pdf American Psychiatric Publishing PMC |
| spellingShingle | Donohue, Julie O'Malley, A. James Horvitz-Lennon, Marcela Taub, Anna Levine Berndt, Ernst R. Huskamp, Haiden A. Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007 |
| title | Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007 |
| title_full | Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007 |
| title_fullStr | Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007 |
| title_full_unstemmed | Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007 |
| title_short | Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007 |
| title_sort | changes in physician antipsychotic prescribing preferences 2002 2007 |
| url | http://hdl.handle.net/1721.1/98494 https://orcid.org/0000-0002-6388-0768 |
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