Antipsychotic prescribing: do conflict of interest policies make a difference?
Antipsychotic prescribing: do conflict of interest policies make a difference?
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DOI：
10.1097/mlr.0000000000000329
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发表时间：
2015-04
期刊：
影响因子：
3
通讯作者：
Donohue JM
中科院分区：
文献类型：
--
作者：
Anderson TS;Huskamp HA;Epstein AJ;Barry CL;Men A;Berndt ER;Horvitz-Lennon M;Normand SL;Donohue JM
学术医疗中心（AMC）越来越多地采用利益冲突政策来管理医生与行业的关系;目前还不清楚政策如何影响处方。确定九个美国医学院协会（AAMC）推荐的政策是否影响精神科医生的抗精神病药物处方，并比较学术和非学术精神科医生之间的处方。我们测量了2008年至2011年期间101个AMC的2，464名学术精神科医生和11，201名非学术精神科医生中10种大力推广和9种新引入/重新配制的抗精神病药物的处方数量。我们测量了AMC对9项AAMC建议的遵守情况。差异中差异分析比较了2008年至2011年期间AMC中符合≥7/9推荐的精神科医生、机构依从性较低的精神科医生和非学术精神科医生中抗精神病药物处方的变化。2008年有10家中心符合AAMC标准，到2011年有30家达到标准，61家从未符合标准。学术和非学术精神科医生之间大力推广的抗精神病药物处方的比例稳定且相当（2008年为63.0-65.8%，2011年为62.7-64.4%）。与从不依从的中心相比，AAMC依从中心的精神科医生开这些抗精神病药物的可能性略低[相对比值比（ROR），0.95，95%CI 0.94-0.97，<0.0001]。新的/重新配制的抗精神病药物处方份额从2008年的5.3%增长到2011年的11.1%。在符合AAMC标准的中心，精神科医生实际上增加了新的/重新配制的抗精神病药物的处方，相对于从未符合AAMC标准的中心（ROR 1.39，95% CI 1.35-1.44，p<0.0001），相对概率增加了1.1%。精神科医生暴露于严格的利益冲突政策，规定大力推广抗精神病药物的比率类似于学术精神科医生，非学术精神科医生暴露于不太严格或没有政策。
Academic medical centers (AMCs) have increasingly adopted conflict of interest policies governing physician-industry relationships; it is unclear how policies impact prescribing. Determine whether nine American Association of Medical Colleges (AAMC)-recommended policies influence psychiatrists’ antipsychotic prescribing and compare prescribing between academic and non-academic psychiatrists. We measured number of prescriptions for 10 heavily-promoted and 9 newly-introduced/reformulated antipsychotics between 2008 and 2011 among 2,464 academic psychiatrists at 101 AMCs and 11,201 non-academic psychiatrists. We measured AMC compliance with 9 AAMC recommendations. Difference-in-difference analyses compared changes in antipsychotic prescribing between 2008 and 2011 among psychiatrists in AMCs compliant with ≥7/9 recommendations, those whose institutions had lesser compliance, and non-academic psychiatrists. Ten centers were AAMC-compliant in 2008, 30 attained compliance by 2011, and 61 were never compliant. Share of prescriptions for heavily promoted antipsychotics was stable and comparable between academic and non-academic psychiatrists (63.0-65.8% in 2008 and 62.7-64.4% in 2011). Psychiatrists in AAMC-compliant centers were slightly less likely to prescribe these antipsychotics compared to those in never compliant centers [Relative Odds Ratio (ROR), 0.95, 95% CI 0.94-0.97, <0.0001]. Share of prescriptions for new/reformulated antipsychotics grew from 5.3% in 2008 to 11.1% in 2011. Psychiatrists in AAMC-compliant centers actually increased prescribing of new/reformulated antipsychotics relative to those in never-compliant centers (ROR 1.39, 95% CI 1.35-1.44, p<0.0001), a relative increase of 1.1% in probability. Psychiatrists exposed to strict conflict of interest policies prescribed heavily promoted antipsychotics at rates similar to academic psychiatrists non-academic psychiatrists exposed to less strict or no policies.