Predictive Modeling of Physician-Patient Dynamics That Influence Sleep Medication Prescriptions and Clinical Decision-Making.
Insomnia remains under-diagnosed and poorly treated despite its high economic and social costs. Though previous work has examined how patient characteristics affect sleep medication prescriptions, the role of physician characteristics that influence this clinical decision remains unclear. We sought to understand patient and physician factors that influence sleep medication prescribing patterns by analyzing Electronic Medical Records (EMRs) including the narrative clinical notes as well as codified data. Zolpidem and trazodone were the most widely prescribed initial sleep medication in a cohort of 1,105 patients. Some providers showed a historical preference for one medication, which was highly predictive of their future prescribing behavior. Using a predictive model (AUC = 0.77), physician preference largely determined which medication a patient received (OR = 3.13; p = 3 × 10-37). In addition to the dominant effect of empirically determined physician preference, discussion of depression in a patient's note was found to have a statistically significant association with receiving a prescription for trazodone (OR = 1.38, p = 0.04). EMR data can yield insights into physician prescribing behavior based on real-world physician-patient interactions.
Department of Biomedical Informatics, Harvard Medical School, Boston MA, USA.
Andrew L
AL
Beam
Center for Systems Biology; Center for Assessment Technology &Continuous Health (CATCH), Massachusetts General Hospital, Boston MA, USA.|Harvard Medical School, Boston MA, USA.|IBM Research, Cambridge MA, USA.
Uri
U
Kartoun
Merck &Co., Inc., Boston, MA, USA.
Jennifer K
JK
Pai
Merck &Co., Inc., Boston, MA, USA.
Arnaub K
AK
Chatterjee
Merck &Co., Inc West Point, PA, USA.
Timothy P
TP
Fitzgerald
Center for Systems Biology; Center for Assessment Technology &Continuous Health (CATCH), Massachusetts General Hospital, Boston MA, USA.|Harvard Medical School, Boston MA, USA.
Stanley Y
SY
Shaw
Department of Biomedical Informatics, Harvard Medical School, Boston MA, USA.
Isaac S
IS
Kohane
D000066491:Clinical Decision-Making; D015331:Cohort Studies; D011307:Drug Prescriptions; D006801:Humans; D016015:Logistic Models; D008962:Models, Theoretical; D016017:Odds Ratio; D010817:Physician-Patient Relations; D011725:Pyridines / Q000494:pharmacology; D012890:Sleep / Q000502:physiology*; D014196:Trazodone / Q000494:pharmacology; D000077334:Zolpidem
D011725:Pyridines; D000077334:Zolpidem; D014196:Trazodone