Factors in choosing atypical antipsychotics: toward understanding the bases of physicians' prescribing decisions.
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.
Hoblyn
Jennifer
J
Palo Alto Veterans Affairs Health Care System, Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, CA 94304, USA. jhoblyn@stanford.edu
Noda
Art
A
Yesavage
Jerome A
JA
Brooks
John O
JO
Sheikh
Javaid
J
Lee
Tina
T
Tinklenberg
Jared R
JR
Schneider
Bret
B
O'Hara
Ruth
R
Leslie
Douglas L
DL
Rosenheck
Robert A
RA
Kraemer
Helena C
HC
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
D014150:Antipsychotic Agents