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Antipsychotic prescribing: do conflict of interest policies make a difference?
Timothy S Anderson1, Haiden A Huskamp, Andrew J Epstein
1*Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA †Department of Health Care Policy, Harvard Medical School, Boston, MA ‡Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA §Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD ∥Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA ¶MIT Sloan School of Management, Cambridge, MA #RAND Corporation, Pittsburgh, PA **Department of Biostatistics, Harvard School of Public Health, Boston, MA.
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 AAMC-compliant 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.
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