Becker Edmund R, Constantine Robert J, McPherson Marie A, Jones Mary Elizabeth
Department of Health Policy and Management, Rollins School of Public Health at Emory University, Atlanta, Georgia, USA.
J Health Care Finance. 2013 Fall;40(1):40-67.
The rapid growth in the use of antipsychotic medications and their related costs have resulted in states developing programs to measure, monitor, and insure their beneficial relevance to public program populations. One such program developed in the state of Florida has adopted an evidence-based approach to identify prescribers with unusual psychotherapeutic prescription patterns and track their utilization and costs among Florida Medicaid patients. This study reports on the prescriber prescription and cost patterns for adults and children using three measures of unusual antipsychotic prescribing patterns: (1) two antipsychotics for 60 days (2AP60), (2) three antipsychotics for 60 days (3AP60), and (2) two antipsychotics for 90 or more days (2AP90). We find that over the four-year study period there were substantial increases in several aspects of the Florida Medicaid behavioral drug program. Overall, for adults and children, patient participation increased by 29 percent, the number of prescriptions grew by 30 percent, and the number of prescribers that wrote at least one prescription grew 48.5 percent, while Medicaid costs for behavioral drugs increased by 32 percent. But the results are highly skewed. We find that a relatively small number of prescribers account for a disproportionately large share of prescriptions and costs of the unusual antipsychotic prescriptions. In general, the top 350 Medicaid prescribers accounted for more than 70 percent of the unusual antipsychotic prescriptions, and we find that this disparity in unusual prescribing patterns appears to be substantially more pronounced in adults than in children prescribers. For just the top 13 adult and children prescribers, their practice patterns accounted for 11 percent to 21 percent of the unusual prescribing activity and, overall, these 13 top prescribers accounted for 13 percent of the total spent on antipsychotics by the Florida Medicaid program and 9.3 percent of the total expenditure by the state for all drugs. Our findings suggest that a strategy to monitor and ensure patient safety and prescribing patterns that targets a relatively small number of Medicaid providers could have a substantial benefit and prove to be cost effective.
抗精神病药物使用的迅速增长及其相关成本促使各州制定计划，以衡量、监测并确保这些药物对公共项目人群具有有益的相关性。佛罗里达州制定的一个此类计划采用了循证方法，以识别具有异常心理治疗处方模式的开药医生，并跟踪他们在佛罗里达州医疗补助患者中的用药情况及成本。本研究报告了使用三种异常抗精神病药物处方模式衡量指标的成人及儿童开药医生的处方及成本模式：（1）60天内开具两种抗精神病药物（2AP60），（2）60天内开具三种抗精神病药物（3AP60），以及（2）90天及以上开具两种抗精神病药物（2AP90）。我们发现，在为期四年的研究期间，佛罗里达州医疗补助行为药物项目的几个方面有大幅增长。总体而言，成人及儿童患者的参与率提高了29%，处方数量增长了30%，至少开具过一张处方的开药医生数量增长了48.5%，而行为药物的医疗补助成本增加了32%。但结果高度不均衡。我们发现，相对少数的开药医生开出了占比过高的异常抗精神病药物处方及成本。一般来说，350名顶级医疗补助开药医生开出了超过70%的异常抗精神病药物处方，而且我们发现，这种异常处方模式的差异在成人开药医生中似乎比儿童开药医生中更为明显。仅前13名成人及儿童开药医生，他们的执业模式就占异常处方活动的11%至21%，总体而言，这13名顶级开药医生占佛罗里达州医疗补助项目抗精神病药物总支出的13%，占该州所有药物总支出的9.3%。我们的研究结果表明，针对相对少数医疗补助提供者监测并确保患者安全及处方模式的策略可能会带来巨大益处，并证明具有成本效益。
