Physicians' prescribing preferences were a potential instrument for patients' actual prescriptions of antidepressants
Physicians' prescribing preferences were a potential instrument for patients' actual prescriptions of antidepressants
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DOI：
10.1016/j.jclinepi.2013.06.008
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发表时间：
2013-12-01
影响因子：
7.2
通讯作者：
Martin, Richard M.
中科院分区：
文献类型：
--
作者：
Davies, Neil M.;Gunnell, David;Martin, Richard M.
目的：为了调查医生的处方偏好是否是有效的工具变量的抗抑郁药处方，他们发出给他们的patient.Study设计和设置：我们调查是否医生的处方（1）三环类抗抑郁药（TCAs）与选择性5-羟色胺再摄取抑制剂（SSRIs）和（2）帕罗西汀与其他SSRIs的有效工具。我们调查了工具变量假设是否可能成立，以及TCA（与SSRIs）是否与入院自残或自杀死亡相关，使用传统和工具变量回归。该研究的背景是在英国的一般做法。结果：以前的处方与实际处方密切相关：以前开过TCA处方的医生为14.9个百分点（95%可信区间[CI]，14.4，15.4）更有可能开TCA，而那些以前开过帕罗西汀的人为27.7个百分点（95% CI，26.7，28.8）更有可能给他们的下一个病人开帕罗西汀。与实际处方相比，医生先前的处方与患者的基线特征的相关性较低。我们没有发现任何证据表明，估计协会的TCAs与自我伤害/自杀使用工具变量回归不同于传统的回归估计（P值= 0.45）。结论：主要工具变量的假设举行，这表明医生的处方偏好是有效的工具，用于评估抗抑郁药的短期影响。(C)2013作者爱思唯尔公司出版All rights reserved.
Objectives: To investigate whether physicians' prescribing preferences were valid instrumental variables for the antidepressant prescriptions they issued to their patients.Study Design and Setting: We investigated whether physicians' previous prescriptions of (1) tricyclic antidepressants (TCAs) vs. selective serotonin reuptake inhibitors (SSRIs) and (2) paroxetine vs. other SSRIs were valid instruments. We investigated whether the instrumental variable assumptions are likely to hold and whether TCAs (vs. SSRIs) were associated with hospital admission for self-harm or death by suicide using both conventional and instrumental variable regressions. The setting for the study was general practices in the United Kingdom.Results: Prior prescriptions were strongly associated with actual prescriptions: physicians who previously prescribed TCAs were 14.9 percentage points (95% confidence interval [CI], 14.4, 15.4) more likely to prescribe TCAs, and those who previously prescribed paroxetine were 27.7 percentage points (95% CI, 26.7, 28.8) more likely to prescribe paroxetine, to their next patient. Physicians' previous prescriptions were less strongly associated with patients' baseline characteristics than actual prescriptions. We found no evidence that the estimated association of TCAs with self-harm/suicide using instrumental variable regression differed from conventional regression estimates (P-value = 0.45).Conclusion: The main instrumental variable assumptions held, suggesting that physicians' prescribing preferences are valid instruments for evaluating the short-term effects of antidepressants. (C) 2013 The Authors. Published by Elsevier Inc. All rights reserved.