Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, USA.
Psychiatr Serv. 2013 Apr 1;64(4):324-30. doi: 10.1176/appi.ps.201200186.
The authors examined physician adoption of second-generation antipsychotic medications and identified physician-level factors associated with early adoption.
The authors estimated Cox proportional-hazards models of time to adoption of nine second-generation antipsychotics by 30,369 physicians who prescribed antipsychotics between 1996 and 2008, when the drugs were first introduced, and analyzed the total number of agents prescribed during that time. The models were adjusted for physicians' specialty, demographic characteristics, education and training, practice setting, and prescribing volume. Data were from IMS Xponent, which captures over 70% of all prescriptions filled in the United States, and the American Medical Association Physician Masterfile.
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 than psychiatrists to adopt second-generation antipsychotics (hazard ratios (HRs) range .10-.35), and solo practitioners were slower than group practitioners to adopt most products (HR range .77-.89). Physicians with the highest antipsychotic-prescribing volume adopted second-generation antipsychotics much faster than physicians with the lowest volume (HR range .15-.39). Psychiatrists tended to prescribe a broader set of antipsychotics (median=6) than general practitioners and neurologists (median=2) and pediatricians (median=1).
As policy makers search for ways to control rapid health spending growth, understanding the factors that influence physician adoption of new medications will be crucial in the efforts to maximize the value of care received by individuals with mental disorders as well as to improve medication safety.
作者研究了医生对第二代抗精神病药物的采用情况，并确定了与早期采用相关的医生层面的因素。
作者通过对 1996 年至 2008 年间（首次推出这些药物时）开处抗精神病药物的 30369 名医生，估计了他们采用九种第二代抗精神病药物的 Cox 比例风险模型，并分析了在此期间开处的药物总数。该模型调整了医生的专业、人口统计学特征、教育和培训、实践环境以及处方量。数据来自 IMS Xponent，它覆盖了美国所有处方的 70%以上，以及美国医学协会医师主档案。
平均而言，医生在开处新的第二代抗精神病药物之前等待了两年或更长时间，但在采用时间上，不同产品之间存在很大的异质性。全科医生比精神科医生采用第二代抗精神病药物的速度慢得多（风险比（HR）范围为.10-.35），个体执业者比团体执业者采用大多数产品的速度慢（HR 范围为.77-.89）。开处抗精神病药物量最高的医生比开处量最低的医生采用第二代抗精神病药物的速度快得多（HR 范围为.15-.39）。精神科医生比全科医生和神经科医生（中位数=2）以及儿科医生（中位数=1）更倾向于开处更多种类的抗精神病药物（中位数=6）。
随着政策制定者寻找控制医疗保健支出快速增长的方法，了解影响医生采用新药物的因素将是至关重要的，这将有助于最大限度地提高接受精神障碍治疗的个人的护理价值，并提高药物安全性。
