title: Gonadotropin-releasing hormone agonist overuse: urologists' response to reimbursement and characteristics associated with persistent overuse.
abstract: BACKGROUND
  Medicare reimbursement cuts have been associated with declining gonadotropin-releasing hormone (GnRH) agonist overuse in localized prostate cancer. Medical school affiliation and foreign training have been associated with persistent overuse. However, physician-level prescribing changes and the practice type of persistent overusers have not been examined. We sought to describe physician-level changes in GnRH agonist overuse and test the association of time in practice and solo practice type with GnRH agonist overuse.
  
  
  METHODS
  We matched American Medical Association physician data for 2138 urologists to Surveillance, Epidemiology and End Result-Medicare data for 12,943 men diagnosed with early-stage and lower-grade adenocarcinoma of the prostate between 2000 and 2007. We conducted a population-based, retrospective study using multilevel modeling to control for patient and provider characteristics.
  
  
  RESULTS
  Three distinct patterns of GnRH agonist overuse were observed. Urologists' time in practice was not associated with GnRH agonist overuse (odds ratio (OR) 0.89; 95% confidence interval (CI): 0.75-1.05). However, solo practice type (OR 1.65; 95% CI: 1.34-2.02), medical school affiliation (OR 0.65; 95% CI: 0.55-0.77) and patient race were. Compared with non-Hispanic whites, non-Hispanic blacks (OR 1.76; 95% CI: 1.37-2.27), Hispanics (OR 1.41; 95% CI: 1.12-1.79) and men of 'other' race (OR 1.44; 95% CI: 1.04-1.99) had greater odds of receiving unnecessary GnRH agonists.
  
  
  CONCLUSIONS
  GnRH agonist overuse remains high among some urologists who may be professionally isolated and difficult to reach. These urologists treat more vulnerable populations, which may contribute to health disparities in prostate cancer treatment quality. Nonetheless, these findings provide guidance to develop interventions to address overuse in prostate cancer.
authors: 1] Department of Health Policy and Management, University of Kansas School of Medicine, Kansas City, KS, USA [2] Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: S D
authors: SD
authors: Ellis
authors: 1] Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA [2] Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: M E
authors: ME
authors: Nielsen
authors: 1] Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA [2] Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: W R
authors: WR
authors: Carpenter
authors: 1] Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA [2] Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA.
authors: G L
authors: GL
authors: Jackson
authors: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: S B
authors: SB
authors: Wheeler
authors: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors: H
authors: H
authors: Liu
authors: 1] Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA [2] Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
authors: M
authors: M
authors: Weinberger
mesh_terms: D000368:Aged; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D006278:Medicare; D010820:Physicians; D010818:Practice Patterns, Physicians'; D000067490:Prescription Drug Overuse; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States
chemical_list: D007987:Gonadotropin-Releasing Hormone