Influences on Psychiatrist Prescribing of Antipsychotics

描述(申请人提供)：抗精神病药物的使用，2009年最畅销的药物类别，也是最近州医疗补助药房支出增长的主要驱动力，自从推出几种非典型抗精神病药物以来，在过去的20年里发生了巨大的变化。最近，食品和药物管理局(FDA)的警告和比较有效性研究指出，与使用非典型药物相关的风险增加，并对其成本效益提出了质疑。关于精神科医生如何采用新药，或者当关于精神科药物有效性和/或安全性的新证据出现时，他们是否以及如何改变他们的执业模式，人们知之甚少。重要的是，我们对促进或抑制精神科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。使用与AMA主文件中的医生特征相关的从IMS Health开出抗精神病药物的所有精神科医生的独特医生级别数据、医疗保健组织服务数据中的医生从属关系、制药商推广努力的数据、当地环境特征的数据以及1997-2011年期间关于抗精神病药物覆盖的国家医疗补助和医疗保险政策的数据，我们将：1)表征精神科医生采用新的抗精神病药物的速度，并确定与早期采用与后期采用相关的因素；2)检查精神科医生对比较有效性研究和安全信息的反应，并确定与精神科医生反应相关的因素；以及3)评估商业影响(例如，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物治疗的质量和效率的担忧取决于改变个别医生的行为。然而，我们不知道何时以及如何针对干预措施，也不知道哪些干预措施是最有效的。如果我们发现，精神科医生处方的大部分差异是由他们何时何地接受培训来解释的，那么就应该加强努力，改善精神科住院医师在精神药理学和循证医学方面的培训。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差异，这些发现将激励组织和政策层面的干预。。 公共卫生相关性：通过表征精神科医生对新的抗精神病药物的采用，并确定影响精神科医生对相对有效性和安全性信息的反应的因素，如教育和培训、组织特征、制药商推广和政策因素，这项研究将提供关于精神科医生如何做出处方决策和对新的临床信息做出反应的重要数据。了解精神科医生如何将新药物和新证据应用到他们的实践中，对于制定临床和政策干预措施以提高精神科药物使用的效率和质量至关重要。

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. . PUBLIC HEALTH RELEVANCE: By characterizing psychiatrist adoption of new antipsychotic medications and identifying factors that influence psychiatrist response to comparative effectiveness and safety information, such as education and training, organizational characteristics, pharmaceutical manufacturer promotion, and policy factors, this study will provide important data on how psychiatrists make prescribing decisions and respond to new clinical information. Understanding how psychiatrists adopt new medications and new evidence into their practice is critical to developing clinical and policy interventions to improve the efficiency and quality of psychiatric medication use.