患者、医生和组织对抗精神病药物处方行为变异的影响。

IF 1 4区 医学 Q4 HEALTH POLICY & SERVICES
Yan Tang, Chung-Chou H Chang, Judith R Lave, Walid F Gellad, Haiden A Huskamp, Julie M Donohue
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引用次数: 0

摘要

背景:医生在许多治疗类别的药物处方中面临多种成分的选择。对于治疗反应具有相当大的患者异质性的情况,根据个体患者的需求和偏好定制治疗可能会改善结果。研究目的:评估精神健康状况的抗精神病药物处方多样性的变化,这是个体化治疗的必要条件,但不是充分条件。确定与抗精神病药物处方多样性相关的患者病例量、医生和组织因素。方法:使用2011年宾夕法尼亚州医疗补助计划、IMS Health的HCOSTM数据库和AMA Masterfile的数据,我们确定了764名给10名患者开抗精神病药物的精神科医生。我们构建了三个医生层面的抗精神病药物处方多样性/浓度指标:处方成分数量、最优选成分的处方份额和赫芬达尔-赫希曼指数(HHI)。我们使用多成员线性混合模型来检验患者病例量、医生和医疗保健组织对医生抗精神病药物处方浓度的预测。结果:精神科医生的抗精神病药物处方浓度存在很大的差异,成分数量在2-17之间,最喜欢的成分占比在16%-85%之间,HHI在1,088-7,270之间。平均而言,精神科医生的处方行为相对多样化;然而,11%的精神科医生在他们的处方中,平均有55%的处方是他们最喜欢的成分。平均而言,女性开处方者和残疾或严重精神疾病患者比例较小的开处方者的开处方行为更集中。讨论:在一个大的州医疗补助计划中,精神科医生的抗精神病药物处方在精神科医生之间存在很大差异。我们的研究结果说明了理解医生开处方行为的重要性,并表明即使在定期开治疗类别的专业中,一些医生也严重依赖少数药物。对卫生政策、卫生保健提供和使用的影响:卫生系统可能需要向临床医生提供教育干预措施,以提高他们根据个别患者的需要制定治疗决策的能力。对未来研究的启示:未来的研究应该检查抗精神病药物处方多样性的影响,以确定更多样化的处方是否能改善患者的依从性和结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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

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

Background: Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes.

Aims of the study: To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment. To identify patient caseload, physician, and organizational factors associated with the diversity of antipsychotic prescribing.

Methods: Using 2011 data from Pennsylvania's Medicaid program, IMS Health's HCOSTM database, and the AMA Masterfile, we identified 764 psychiatrists who prescribed antipsychotics to 10 patients. We constructed three physician-level measures of diversity/concentration of antipsychotic prescribing: number of ingredients prescribed, share of prescriptions for most preferred ingredient, and Herfindahl-Hirschman index (HHI). We used multiple membership linear mixed models to examine patient caseload, physician, and healthcare organizational predictors of physician concentration of antipsychotic prescribing.

Results: There was substantial variability in antipsychotic prescribing concentration among psychiatrists, with number of ingredients ranging from 2-17, share for most preferred ingredient from 16%-85%, and HHI from 1,088-7,270. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient. Female prescribers and those with smaller shares of disabled or serious mental illness patients had more concentrated prescribing behavior on average.

Discussion: Antipsychotic prescribing by individual psychiatrists in a large state Medicaid program varied substantially across psychiatrists. Our findings illustrate the importance of understanding physicians' prescribing behavior and indicate that even among specialties regularly prescribing a therapeutic category, some physicians rely heavily on a small number of agents.

Implications for health policies, health care provision and use: Health systems may need to offer educational interventions to clinicians in order to improve their ability to tailor treatment decisions to the needs of individual patients.

Implications for future research: Future studies should examine the impact of the diversity of antipsychotic prescribing to determine whether more diversified prescribing improves patient adherence and outcomes.

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来源期刊
CiteScore
2.20
自引率
6.20%
发文量
8
期刊介绍: The Journal of Mental Health Policy and Economics publishes high quality empirical, analytical and methodologic papers focusing on the application of health and economic research and policy analysis in mental health. It offers an international forum to enable the different participants in mental health policy and economics - psychiatrists involved in research and care and other mental health workers, health services researchers, health economists, policy makers, public and private health providers, advocacy groups, and the pharmaceutical industry - to share common information in a common language.
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