アカデミック・メディカル・センターの医薬品詳細ポリシーと医師の処方との関連
Ian Larkin1, Desmond Ang2, Jonathan Steinhart3
1University of California, Los Angeles.
JAMA
|May 3, 2017
まとめ
アカデミック・メディカル・センター (AMC) は,医薬品の詳細を制限することで,詳細薬の処方量をわずかに削減しました. 政策は,研究された8つの薬物クラスのうち6つの医師の処方パターンの有意な変化と関連していました.
科学分野:
- 健康政策
- 医学経済学
- 医薬品 マーケティング
背景:
- アカデミック・メディカル・センターは,2006年から2012年にかけて,医薬品販売担当者の訪問を制限することで,医師の利益相反を規制する方針を実施した (詳細).
- これらの詳細な方針が医師の処方パターンに与える影響はほとんど知られていなかった.
研究 の 目的:
- AMCで制定された詳細な政策と,医師が積極的に詳細な対非詳細な薬を処方するとの関連を分析する.
- 特定の薬物クラスにおける薬物市場シェアに対するこれらの政策の影響を評価する.
主な方法:
- 多変数回帰分析を用いた.
- 19の介入医療センターの医師からの処方データ (詳細な方針を含む) を,そのような方針に従わない医師の対照グループと比較した.
- 8つの主要な薬物クラスにおける詳細および非詳細の薬物クラス内の月間市場シェアは,政策の実施前と後に分析されました.
主要な成果:
- 詳細な医薬品の市場シェアが統計的に有意な減少 (1.67パーセントポイント) と,詳細でない医薬品の市場シェアが有意な増加 (0.84パーセントポイント) と関連していた.
- これらの関連性は,脂質低下薬,胃食道逆流症,抗高血圧薬,睡眠補助薬,注意欠陥/多動性障害,および抗うつ薬を含む8つの薬剤クラスで有意であった.
- 総合的な政策 (贈与,アクセス,執行を規制する) を採用した医療センターは,より厳格な政策を導入した医療センターと比較して,処方におけるより大きな変化を示した.
結論:
- 医薬品の詳細制限政策の実施は,詳細薬の処方量の控えめだが有意な減少と関連していた.
- これらの政策の有効性は様々で,8つの薬剤クラスのうち6つと,研究された19のAMCのうち9つで著しい処方変化が観察されました.
- 贈与制限やアクセス制限を含む包括的な政策の実施は,医師の処方行動のより顕著な変化と相関しています.
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