title: Factors in choosing atypical antipsychotics: toward understanding the bases of physicians' prescribing decisions.
abstract: OBJECTIVE
  Off-label prescribing of medications, polypharmacy, and other questionable prescribing practices have led investigators to examine a large VA pharmacy database to determine if physician prescribing decisions appear reasonable.
  
  
  METHODS
  The current study addresses the question of physician prescribing of atypical antipsychotics in 34,925 veterans with schizophrenia, using a series of signal detection analyses.
  
  
  RESULTS
  These results suggest that only three factors (hospital size, age, and secondary diagnosis) allow classification of patients prescribed atypicals into three groups with frequencies of use of atypicals ranging from 43% to 79%, and that these results are consistent with reasonable clinical practice.
  
  
  CONCLUSIONS
  Results of two-stage signal detection analyses are readily interpretable by clinicians and administrators who are faced with the task of evaluating how physicians prescribe medications in clinical practice. Physicians' decisions to prescribe atypical antipsychotics are based on both patient and fiscal considerations. This likely reflects a combination of clinical judgment and institutional guidelines.
authors.affiliation: Palo Alto Veterans Affairs Health Care System, Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, CA 94304, USA. jhoblyn@stanford.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hoblyn
authors.forename: Art
authors.initials: A
authors.lastname: Noda
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Yesavage
authors.forename: John O
authors.initials: JO
authors.lastname: Brooks
authors.forename: Javaid
authors.initials: J
authors.lastname: Sheikh
authors.forename: Tina
authors.initials: T
authors.lastname: Lee
authors.forename: Jared R
authors.initials: JR
authors.lastname: Tinklenberg
authors.forename: Bret
authors.initials: B
authors.lastname: Schneider
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Hara
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Leslie
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: Helena C
authors.initials: HC
authors.lastname: Kraemer
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003657:Decision Making; D003659:Decision Making, Organizational; D011307:Drug Prescriptions / Q000191:economics* / Q000706:statistics & numerical data*; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005163:Factor Analysis, Statistical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D010820:Physicians; D012372:ROC Curve; D012559:Schizophrenia / Q000188:drug therapy*; D017603:Signal Detection, Psychological; D014728:Veterans / Q000523:psychology
chemical_list: D014150:Antipsychotic Agents