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Articles   |    
Changes in Physician Antipsychotic Prescribing Preferences, 2002–2007
Julie Donohue, Ph.D.; A. James O'Malley, Ph.D.; Marcela Horvitz-Lennon, M.D., M.P.H.; Anna Levine Taub, Ph.D.; Ernst R. Berndt, Ph.D.; Haiden A. Huskamp, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200536
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Dr. Donohue is with the Graduate School of Public Health, University of Pittsburgh (e-mail: jdonohue@pitt.edu). Dr. O'Malley is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire. Dr. Horvitz-Lennon is with the RAND Corporation, Pittsburgh. Dr. Taub is with the Department of Economics, Northeastern University, Boston. Dr. Berndt is with the Sloan School of Management, Massachusetts Institute of Technology, Cambridge. Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston. Some of the findings were presented at the National Institute of Mental Health’s Mental Health Services Research Conference, July 27–28, 2011, Bethesda, Maryland, and at the Workshop on Costs and Assessment in Psychiatry, Venice, Italy, March 22–24, 2013.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Physician antipsychotic prescribing behavior may be influenced by comparative effectiveness evidence, regulatory warnings, and formulary and other restrictions on these drugs. This study measured changes in the degree to which physicians are able to customize treatment choices and changes in physician preferences for specific agents after these events.

Methods  The study used 2002–2007 prescribing data from the IMS Health Xponent database and data on physician characteristics from the American Medical Association for a longitudinal cohort of 7,399 physicians. Descriptive and multivariable regression analyses were conducted of the concentration of prescribing (physician-level Herfindahl index) and preferences for and likelihood of prescribing two first-generation antipsychotics and six second-generation antipsychotics. Analyses adjusted for prescribing volume, specialty, demographic characteristics, practice setting, and education.

Results  Antipsychotic prescribing was highly concentrated at the physician level, with a mean unadjusted Herfindahl index of .33 in 2002 and .29 in 2007. Psychiatrists reduced the concentration of their prescribing more over time than did other physicians. High-volume psychiatrists had a Herfindahl index that was half that of low-volume physicians in other specialties (.18 versus .36), a difference that remained significant (p<.001) after adjustment for physician characteristics. The share of physicians preferring olanzapine dropped from 29.9% in 2002 to 10.3% in 2007 (p<.001) while the share favoring quetiapine increased from 9.4% to 44.5% (p<.001). Few physicians (<5%) preferred a first-generation antipsychotic in 2002 or 2007.

Conclusions  Preferences for specific antipsychotics changed dramatically during this period. Although physician prescribing remained heavily concentrated, the concentration decreased over time, particularly among psychiatrists.

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Figure 1 Changes in preferred antipsychotic medication among 7,399 physicians between 2002 and 2007a

a Source: IMS Xponent, January 2002–December 2007, IMS Health Inc. The preferred medication is the product for which the physician’s patients filled the most prescriptions in a given year.

Figure 2 Quarterly share (percentage) of prescriptions written for antipsychotics among 2,215 physicians who favored olanzapine above other antipsychotics in 2002a

a Source: IMS Xponent, January 2002–December 2007, IMS Health Inc.

Figure 3 Percentage of 7,399 physicians prescribing antipsychoticsa

a Source: IMS Xponent, January 2002–December 2007, IMS Health Inc.

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Table 1Characteristics of physicians prescribing antipsychotics in 2002a
Table Footer Note

a Sources: IMS Xponent, January 2002–December 2007, IMS Health Inc. and American Medical Association (AMA) Masterfile, 2002–2007. Sample includes physicians with 20 or more antipsychotic prescriptions both in 2002 and in 2007.

Table Footer Note

b Includes general practitioners (internal medicine, family practice, and primary care) and physicians from other specialties (neurology and pediatrics)

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Table 2Analysis of variables as predictors of the concentration of physician prescribing of antipsychoticsa
Table Footer Note

a Fixed effects for U.S. state were included in the analysis.

Table Footer Note

b AMA, American Medical Association

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