Influences on Psychiatrist Prescribing of Antipsychotics

描述（由申请人提供）：抗精神病药物的使用，是2009年最畅销的药物类别，也是最近国家医疗补助药房支出增长的主要驱动力，自几种非典型抗精神病药物引入以来，在过去的二十年中发生了巨大变化。最近，美国食品和药物管理局（FDA）的警告和比较有效性研究指出，使用非典型药物会增加风险，并对其成本效益提出了质疑。对于精神科医生如何采用新药物，或者当精神科药物的有效性和/或安全性出现新的证据时，他们是否以及如何改变他们的实践模式，人们知之甚少。重要的是，我们对促进或抑制精神病医生对新的安全性和有效性信息的反应的提供者、组织和政策层面的因素知之甚少。使用独特的医生层面的抗精神病药物处方数据，所有开抗精神病药物处方的精神科医生都来自IMS Health，与AMA Masterfile中的医生特征相关联，医生与医疗保健组织的隶属关系来自医疗保健组织服务数据，药品制造商的促销努力数据，当地环境特征数据，以及1997-2011年国家医疗补助和医疗保险政策中抗精神病药物覆盖范围的数据，我们将：1)表征精神科医生采用新型抗精神病药物的速度，并确定与早期和晚期采用相关的因素；2)检查精神科医生对比较有效性研究和安全性信息的反应，并确定与精神科医生反应相关的因素；3)评估商业影响（如制造商促销）和政策因素（如医疗补助和医疗保险药物覆盖限制）是否会影响精神科医生对药物信息的反应。解决对精神障碍患者的精神药理学护理的质量和效率的关注取决于改变个体医生的行为。然而，我们不知道何时以及如何采取干预措施，也不知道哪些干预措施最有效。如果我们发现精神科医生的处方差异很大程度上是由他们在何时何地接受过培训来解释的，那么我们就应该加强在精神药理学和循证医学方面改进精神科住院医师培训的努力。或者，如果组织因素、药物推广和/或政策因素解释了处方行为的大部分变化，这些发现将激励组织和政策层面的干预。

DESCRIPTION (provided by applicant): Use of antipsychotic medications, the top selling medication class in 2009 and a primary driver of recent growth in state Medicaid pharmacy expenditure, has changed dramatically in the past two decades since the introduction of several atypical antipsychotics. Recently, Food and Drug Administration (FDA) warnings and comparative effectiveness research have pointed to elevated risks associated with use of atypicals and have raised questions about their cost-effectiveness. Little is known about how psychiatrists adopt new medications, or whether and how they change their practice patterns when new evidence emerges on psychiatric drug efficacy and/or safety. Importantly, we know little about the provider-, organizational- and policy-level factors that promote or inhibit psychiatrists' response to new safety and efficacy information. Using unique physician-level data on antipsychotic prescribing for all psychiatrists who prescribe antipsychotic medications from IMS Health linked with physician characteristics from the AMA Masterfile, physician affiliations with health care organizations from the Health Care Organization Services data, data on pharmaceutical manufacturers' promotional efforts, data on local environmental characteristics, and data on state Medicaid and Medicare policies on coverage of antipsychotics for the period 1997-2011, we will: 1) characterize the speed of adoption of new antipsychotic medications among psychiatrists and identify factors associated with early vs. late adoption; 2) examine psychiatrists' responses to comparative effectiveness research and safety information and identify factors associated with a psychiatrist's response; and 3) evaluate whether commercial influences (e.g., manufacturer promotion) and policy factors, such as Medicaid and Medicare drug coverage restrictions, influence psychiatrists' responses to drug information. Addressing concerns about the quality and efficiency of psychopharmacologic care for people with mental disorders depends on changing the behavior of individual physicians. However, we do not know when and how to target interventions nor which interventions are most effective. Should we find that much of the variation in psychiatrists' prescribing is explained by where and when they trained then efforts to improve psychiatric residency training in psychopharmacology and evidence-based medicine should be intensified. Alternatively, if organizational factors, pharmaceutical promotion and/or policy factors explain much of the variation in prescribing behaviors, such findings would motivate interventions at the organizational and policy-level. .