title: Impact of a program encouraging the use of generic antipsychotics.
abstract: Recent research suggests that second generation antipsychotics (SGAs) may be used more often than clinically warranted. An intervention consisting of academic detailing and a prescriber survey was employed to encourage the reduction of newly prescribed on-patent SGAs.
  
  
  
  Quasi-experimental quality improvement trial.
  
  
  
  Academic detailing consisted of educational lectures and a pocket guide on the latest effectiveness, safety, and cost data for SGAs and first-generation antipsychotics. Detailing was coupled with a required 20-item survey of provider decision making completed prior to prescriptions for on-patent SGAs at a Veterans Health Administration medical center between October 2007 and May 2009. The survey identified the medication, treated diagnosis, comorbid psychiatric and medical diagnoses, reasons for the medication, prior medications, and provider professional status. The outcome was the number of new SGA prescriptions per month.
  
  
  
  The sample included 2176 surveys. The Spearman correlation between the number of prescriptions and the intervention month (range = 1-18) was 0.25 (P = .31), indicating no reduction. The most common medication prescribed was quetiapine (55.8%). The distributions of diagnoses were fairly even among schizophrenia, bipolar disorder, other affective disorders, and posttraumatic stress disorder (17.0, 28.2, 25.8, and 20.4%, respectively). The 3 most common reasons for prescribing an SGA were to improve efficacy (49.8%), reduce side effects (29.1%), and increase sleep or sedation (34.5%).
  
  
  
  Academic detailing coupled with a provider survey did not decrease the rate of new prescriptions for on-patent SGAs. Reasons for prescribing SGAs were not consistent with recent research findings regarding efficacy and side effects.
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA. eric.hermes@yale.edu
authors.forename: Eric D A
authors.initials: ED
authors.lastname: Hermes
authors.forename: Michael
authors.initials: M
authors.lastname: Sernyak
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D016568:Drugs, Generic / Q000627:therapeutic use*; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D009042:Motivation; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D018709:Statistics, Nonparametric
chemical_list: D014150:Antipsychotic Agents; D016568:Drugs, Generic