Provider and Patient Determinants of Generic Levothyroxine Prescribing: An Electronic Health Records–Based Study

Robert J. Romanelli, Vani Nimbal, Sarah K. Dutcher, Xia Pu, Jodi Segal

Research output: Contribution to journalArticle

Abstract

Background: Despite the availability of generic levothyroxine products for more than a decade, uptake of these products is poor. Objective: We sought to evaluate determinants of generic prescribing of levothyroxine. Methods: In a cross-sectional analysis of electronic health records data between 2010 and 2013, we identified adult patients with a levothyroxine prescription from a primary-care physician (PCP) or endocrinologist. We used mixed-effect logistic regression models with random intercepts for prescribing provider to examine predictors of generic levothyroxine prescribing. Models include patient, prescription, and provider fixed-effect covariates. Odds ratios (ORs) and 95% CIs were generated. Between-provider random variation was quantified by the intraclass correlation coefficient (ICC). Results: Study patients (n = 63 838) were clustered among 941 prescribing providers within 25 ambulatory care clinics. The overall prevalence of generic prescribing of levothyroxine was 73%. In the multivariable mixed-effect model, patients were significantly less likely to receive generic levothyroxine from an endocrinologist than a PCP (OR = 0.43; 95% CI = 0.33-0.55; P < 0.001). Women were less likely to receive generic levothyroxine than men from endocrinologists (OR = 0.68; 95% CI = 0.59-0.78; P < 0.001) but not from PCPs. Between-provider variation in generic prescribing was 18.3% in the absence of fixed-effect covariates and could be explained marginally by patient, prescription, and provider factors (ICC = 15.9%). Conclusions: Generic levothyroxine prescribing differed by PCPs and endocrinologists. Residual variation in generic prescribing, after accounting for measurable factors, indicates the need for provider interventions or patient education aimed at improving levothyroxine generic uptake.

Original languageEnglish (US)
Pages (from-to)640-648
Number of pages9
JournalAnnals of Pharmacotherapy
Volume51
Issue number8
DOIs
StatePublished - Aug 1 2017

Fingerprint

Electronic Prescribing
Thyroxine
Health
Prescriptions
Odds Ratio
Primary Care Physicians
Logistic Models
Electronic Health Records
Patient Education
Ambulatory Care
Cross-Sectional Studies

Keywords

  • electronic health records
  • generic prescribing
  • levothyroxine

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Provider and Patient Determinants of Generic Levothyroxine Prescribing : An Electronic Health Records–Based Study. / Romanelli, Robert J.; Nimbal, Vani; Dutcher, Sarah K.; Pu, Xia; Segal, Jodi.

In: Annals of Pharmacotherapy, Vol. 51, No. 8, 01.08.2017, p. 640-648.

Research output: Contribution to journalArticle

Romanelli, Robert J. ; Nimbal, Vani ; Dutcher, Sarah K. ; Pu, Xia ; Segal, Jodi. / Provider and Patient Determinants of Generic Levothyroxine Prescribing : An Electronic Health Records–Based Study. In: Annals of Pharmacotherapy. 2017 ; Vol. 51, No. 8. pp. 640-648.
@article{8b90d26ad1d349678bed1b9456b33489,
title = "Provider and Patient Determinants of Generic Levothyroxine Prescribing: An Electronic Health Records–Based Study",
abstract = "Background: Despite the availability of generic levothyroxine products for more than a decade, uptake of these products is poor. Objective: We sought to evaluate determinants of generic prescribing of levothyroxine. Methods: In a cross-sectional analysis of electronic health records data between 2010 and 2013, we identified adult patients with a levothyroxine prescription from a primary-care physician (PCP) or endocrinologist. We used mixed-effect logistic regression models with random intercepts for prescribing provider to examine predictors of generic levothyroxine prescribing. Models include patient, prescription, and provider fixed-effect covariates. Odds ratios (ORs) and 95{\%} CIs were generated. Between-provider random variation was quantified by the intraclass correlation coefficient (ICC). Results: Study patients (n = 63 838) were clustered among 941 prescribing providers within 25 ambulatory care clinics. The overall prevalence of generic prescribing of levothyroxine was 73{\%}. In the multivariable mixed-effect model, patients were significantly less likely to receive generic levothyroxine from an endocrinologist than a PCP (OR = 0.43; 95{\%} CI = 0.33-0.55; P < 0.001). Women were less likely to receive generic levothyroxine than men from endocrinologists (OR = 0.68; 95{\%} CI = 0.59-0.78; P < 0.001) but not from PCPs. Between-provider variation in generic prescribing was 18.3{\%} in the absence of fixed-effect covariates and could be explained marginally by patient, prescription, and provider factors (ICC = 15.9{\%}). Conclusions: Generic levothyroxine prescribing differed by PCPs and endocrinologists. Residual variation in generic prescribing, after accounting for measurable factors, indicates the need for provider interventions or patient education aimed at improving levothyroxine generic uptake.",
keywords = "electronic health records, generic prescribing, levothyroxine",
author = "Romanelli, {Robert J.} and Vani Nimbal and Dutcher, {Sarah K.} and Xia Pu and Jodi Segal",
year = "2017",
month = "8",
day = "1",
doi = "10.1177/1060028017705393",
language = "English (US)",
volume = "51",
pages = "640--648",
journal = "Annals of Pharmacotherapy",
issn = "1060-0280",
publisher = "Harvey Whitney Books Company",
number = "8",

}

TY - JOUR

T1 - Provider and Patient Determinants of Generic Levothyroxine Prescribing

T2 - An Electronic Health Records–Based Study

AU - Romanelli, Robert J.

AU - Nimbal, Vani

AU - Dutcher, Sarah K.

AU - Pu, Xia

AU - Segal, Jodi

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background: Despite the availability of generic levothyroxine products for more than a decade, uptake of these products is poor. Objective: We sought to evaluate determinants of generic prescribing of levothyroxine. Methods: In a cross-sectional analysis of electronic health records data between 2010 and 2013, we identified adult patients with a levothyroxine prescription from a primary-care physician (PCP) or endocrinologist. We used mixed-effect logistic regression models with random intercepts for prescribing provider to examine predictors of generic levothyroxine prescribing. Models include patient, prescription, and provider fixed-effect covariates. Odds ratios (ORs) and 95% CIs were generated. Between-provider random variation was quantified by the intraclass correlation coefficient (ICC). Results: Study patients (n = 63 838) were clustered among 941 prescribing providers within 25 ambulatory care clinics. The overall prevalence of generic prescribing of levothyroxine was 73%. In the multivariable mixed-effect model, patients were significantly less likely to receive generic levothyroxine from an endocrinologist than a PCP (OR = 0.43; 95% CI = 0.33-0.55; P < 0.001). Women were less likely to receive generic levothyroxine than men from endocrinologists (OR = 0.68; 95% CI = 0.59-0.78; P < 0.001) but not from PCPs. Between-provider variation in generic prescribing was 18.3% in the absence of fixed-effect covariates and could be explained marginally by patient, prescription, and provider factors (ICC = 15.9%). Conclusions: Generic levothyroxine prescribing differed by PCPs and endocrinologists. Residual variation in generic prescribing, after accounting for measurable factors, indicates the need for provider interventions or patient education aimed at improving levothyroxine generic uptake.

AB - Background: Despite the availability of generic levothyroxine products for more than a decade, uptake of these products is poor. Objective: We sought to evaluate determinants of generic prescribing of levothyroxine. Methods: In a cross-sectional analysis of electronic health records data between 2010 and 2013, we identified adult patients with a levothyroxine prescription from a primary-care physician (PCP) or endocrinologist. We used mixed-effect logistic regression models with random intercepts for prescribing provider to examine predictors of generic levothyroxine prescribing. Models include patient, prescription, and provider fixed-effect covariates. Odds ratios (ORs) and 95% CIs were generated. Between-provider random variation was quantified by the intraclass correlation coefficient (ICC). Results: Study patients (n = 63 838) were clustered among 941 prescribing providers within 25 ambulatory care clinics. The overall prevalence of generic prescribing of levothyroxine was 73%. In the multivariable mixed-effect model, patients were significantly less likely to receive generic levothyroxine from an endocrinologist than a PCP (OR = 0.43; 95% CI = 0.33-0.55; P < 0.001). Women were less likely to receive generic levothyroxine than men from endocrinologists (OR = 0.68; 95% CI = 0.59-0.78; P < 0.001) but not from PCPs. Between-provider variation in generic prescribing was 18.3% in the absence of fixed-effect covariates and could be explained marginally by patient, prescription, and provider factors (ICC = 15.9%). Conclusions: Generic levothyroxine prescribing differed by PCPs and endocrinologists. Residual variation in generic prescribing, after accounting for measurable factors, indicates the need for provider interventions or patient education aimed at improving levothyroxine generic uptake.

KW - electronic health records

KW - generic prescribing

KW - levothyroxine

UR - http://www.scopus.com/inward/record.url?scp=85024100983&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85024100983&partnerID=8YFLogxK

U2 - 10.1177/1060028017705393

DO - 10.1177/1060028017705393

M3 - Article

C2 - 28425295

AN - SCOPUS:85024100983

VL - 51

SP - 640

EP - 648

JO - Annals of Pharmacotherapy

JF - Annals of Pharmacotherapy

SN - 1060-0280

IS - 8

ER -