title: Customization in prescribing for bipolar disorder.
abstract: For many disorders, patient heterogeneity requires physicians to customize their treatment to each patient's needs. We test for the existence of customization in physicians' prescribing for bipolar disorder, using data from a naturalistic clinical effectiveness trial of bipolar disorder treatment (STEP-BD), which did not constrain physician prescribing. Multinomial logit is used to model the physician's choice among five combinations of drug classes. We find that our observed measure of the patient's clinical status played only a limited role in the choice among drug class combinations, even for conditions such as mania that are expected to affect class choice. However, treatment of a patient with given characteristics differed widely depending on which physician was seen. The explanatory power of the model was low. There was variation within each physician's prescribing, but the results do not suggest a high degree of customization in physicians' prescribing, based on our measure of clinical status.
authors.affiliation: Institute for Behavioral Health, Heller School of Social Policy & Management, Brandeis University, Waltham, MA 02454, USA. hodgkin@brandeis.edu
authors.forename: Dominic
authors.initials: D
authors.lastname: Hodgkin
authors.forename: Joanna
authors.initials: J
authors.lastname: Volpe-Vartanian
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Merrick
authors.forename: Constance M
authors.initials: CM
authors.lastname: Horgan
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Richard G
authors.initials: RG
authors.lastname: Frank
authors.forename: Sue
authors.initials: S
authors.lastname: Lee
mesh_terms: D000328:Adult; D000367:Age Factors; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D014150:Antipsychotic Agents