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Factors in choosing atypical antipsychotics: toward understanding the bases of physicians' prescribing decisions.

Hoblyn J, Noda A, Yesavage JA, Brooks JO, Sheikh J, Lee T, Tinklenberg JR, Schneider B, O'Hara R, Leslie DL, Rosenheck RA, Kraemer HC

Palo Alto Veterans Affairs Health Care System, Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto, CA 94304, USA. jhoblyn@stanford.edu

OBJECTIVE: Off-label prescribing of medications, polypharmacy, and other questionable prescribing practices have led investigators to examine a large VA pharmacy database to determine if physician prescribing decisions appear reasonable. METHOD: The current study addresses the question of physician prescribing of atypical antipsychotics in 34,925 veterans with schizophrenia, using a series of signal detection analyses. RESULTS: These results suggest that only three factors (hospital size, age, and secondary diagnosis) allow classification of patients prescribed atypicals into three groups with frequencies of use of atypicals ranging from 43% to 79%, and that these results are consistent with reasonable clinical practice. CONCLUSIONS: Results of two-stage signal detection analyses are readily interpretable by clinicians and administrators who are faced with the task of evaluating how physicians prescribe medications in clinical practice. Physicians' decisions to prescribe atypical antipsychotics are based on both patient and fiscal considerations. This likely reflects a combination of clinical judgment and institutional guidelines.

Published 6 February 2006 in J Psychiatr Res, 40(2): 160-6.
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