How quickly do physicians adopt new drugs? The case of second-generation antipsychotics.
How quickly do physicians adopt new drugs? The case of second-generation antipsychotics.
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DOI：
10.1176/appi.ps.201200186
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发表时间：
2013-04-01
期刊：
影响因子：
--
通讯作者：
Donohue JM
中科院分区：
文献类型：
--
作者：
Huskamp HA;O'Malley AJ;Horvitz-Lennon M;Taub AL;Berndt ER;Donohue JM
研究医生采用第二代抗精神病药物，并确定与早期采用相关的医生水平因素。使用IMS Health Xponent™数据，该数据捕获了美国70%以上的处方，和美国医学会主文件数据的处方者特征的9个第二代抗精神病药物从1996年至2008年介绍了30,369名医生谁开抗精神病药物，我们估计药物特异性的考克斯比例风险模型的时间采用和进行描述性分析的药物处方总数。平均而言，医生在处方新的第二代抗精神病药物之前等待了两年或两年以上，但在采用时间上，产品之间存在很大的异质性。全科医生采用第二代抗精神病药物的速度比精神科医生慢得多（风险比（HR）范围为0.10-0.35）;个体医生采用大多数产品的速度比团体医生慢（HR范围为0.77-0.89）。抗精神病药物处方量最高四分位数的医生采用第二代抗精神病药物的速度比最低四分位数的医生快得多（HR范围为0.15-0.39）。精神科医生倾向于比其他专业（全科医生和神经科医生的中位数为2，儿科医生的中位数为1）开出更广泛的抗精神病药物（中位数为6）。政策制定者正在寻找控制医疗支出快速增长的方法，这主要是由第二代抗精神病药物等新技术的使用驱动的。了解影响医生采用新药物的因素将是至关重要的，在实施旨在最大限度地提高精神障碍患者所接受的护理价值的努力，以及提高用药安全性的努力。
To examine physician adoption of second-generation antipsychotic medications and identify physician-level factors associated with early adoption. Using IMS Health Xponent™ data, which captures over 70% of all prescriptions filled in the U.S., and AMA Masterfile data on prescriber characteristics for each of 9 second-generation antipsychotics introduced from 1996–2008 for 30,369 physicians who prescribed antipsychotics, we estimate drug-specific Cox proportional hazards models of time to adoption and conduct descriptive analysis of the total number of agents prescribed. On average, physicians waited two or more years before prescribing new second-generation antipsychotics, but there was substantial heterogeneity across products in time to adoption. General practitioners were much slower to adopt second-generation antipsychotics than psychiatrists (hazard ratios (HRs) ranged from 0.10–0.35); solo practitioners were slower to adopt most products than group practitioners (HRs ranged from 0.77–0.89). Physicians in the highest quartile of antipsychotic prescribing volume adopted second-generation antipsychotics much faster than physicians in the lowest quartile (HRs ranged from 0.15–0.39). Psychiatrists tended to prescribe a broader set of antipsychotics (median of 6) than other specialties (median of 2 for general practitioners and neurologists and 1 for pediatricians). Policymakers are searching for ways to control rapid health spending growth, which is driven primarily by use of new technologies such as second-generation antipsychotics. Understanding the factors that influence physician adoption of new medications will be crucial in the implementation of efforts aimed at maximizing value of care received by individuals with mental disorders as well as efforts to improve medication safety.
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影响因子：
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通讯作者：
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