Antipsychotic prescribing do conflict of interest policies make a difference?

Timothy S. Anderson, Haiden A. Huskamp, Andrew J. Epstein, Colleen L. Barry, Aiju Men, Ernst R. Berndt, Marcela Horvitz-Lennon, Sharon Lise Normand, Julie M. Donohue

Research output: Contribution to journalArticle

Abstract

Background: Academic medical centers (AMCs) have increasingly adopted conflict of interest policies governing physician-industry relationships; it is unclear how policies impact prescribing. Objectives: To determine whether 9 American Association of Medical Colleges (AAMC)-recommended policies influence psychiatrists' antipsychotic prescribing and compare prescribing between academic and nonacademic psychiatrists. Research Design: We measured number of prescriptions for 10 heavily promoted and 9 newly introduced/reformulated antipsychotics between 2008 and 2011 among 2464 academic psychiatrists at 101 AMCs and 11,201 nonacademic psychiatrists. We measured AMC compliance with 9 AAMC recommendations. Difference-in-difference analyses compared changes in antipsychotic prescribing between 2008 and 2011 among psychiatrists in AMCs compliant with ≥7/9 recommendations, those whose institutions had lesser compliance, and nonacademic psychiatrists. Results: Ten centers were AAMC compliant in 2008, 30 attained compliance by 2011, and 61 were never compliant. Share of prescriptions for heavily promoted antipsychotics was stable and comparable between academic and nonacademic psychiatrists (63.0%-65.8% in 2008 and 62.7%-64.4% in 2011). Psychiatrists in AAMC-compliant centers were slightly less likely to prescribe these antipsychotics compared with those in never-compliant centers (relative odds ratio, 0.95; 95% CI, 0.94-0.97; P<0.0001). Share of prescriptions for new/reformulated antipsychotics grew from 5.3% in 2008 to 11.1% in 2011. Psychiatrists in AAMCcompliant centers actually increased prescribing of new/reformulated antipsychotics relative to those in never-compliant centers (relative odds ratio, 1.39; 95% CI, 1.35-1.44; P< 0.0001), a relative increase of 1.1% in probability. Conclusions: Psychiatrists exposed to strict conflict of interest policies prescribed heavily promoted antipsychotics at rates similar to academic psychiatrists and nonacademic psychiatrists exposed to less strict or no policies.

Original languageEnglish (US)
Pages (from-to)338-345
Number of pages8
JournalMedical care
Volume53
Issue number4
DOIs
StatePublished - Mar 30 2015

Keywords

  • academic medical center
  • antipsychotics
  • pharmaceutical policy
  • practice variation

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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  • Cite this

    Anderson, T. S., Huskamp, H. A., Epstein, A. J., Barry, C. L., Men, A., Berndt, E. R., Horvitz-Lennon, M., Normand, S. L., & Donohue, J. M. (2015). Antipsychotic prescribing do conflict of interest policies make a difference? Medical care, 53(4), 338-345. https://doi.org/10.1097/MLR.0000000000000329