Confronting Clinicians About Overprescribing May Not Make Them Change

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Letters were sent to physicians who were found to be prescribing addictive drugs such as opioids 400% more than colleagues.
Letters were sent to physicians who were found to be prescribing addictive drugs such as opioids 400% more than colleagues.

Attempts to stop clinicians that are suspected of overprescribing addictive drugs, such as amphetamines and opioids, through informative letters, from continuing to do so doesn't appear to do the trick, according to a new study.

Researchers at the Mailman School of Public Health at Columbia University, along with colleagues at MIT, the Centers for Medicare and Medicaid Services (CMS) and the White House Social and Behavioral Team, first determined top prescribers of addictive drugs to target. Data to identify them was collected through a database maintained by CMS. These clinicians, which numbered 1525, on average, prescribed over 400% more controlled substances than their peers.

 

Half of these physicians were then sent letters telling them of their high prescribing rates.  The other half received no communication. The team was unable to see a statistically significant decline in controlled substance prescribing rates after the letters were sent, they reported in the journal Health Affairs.

“Even though we weren't able to show that the letters were effective, this information is still useful for policymakers,” Adam Sacarny, PhD, an assistant professor of health policy and management at Mailman said in a statement. “This is why it's so important to rigorously test these interventions. Based on these results, we're now experimenting with different letter designs and making other changes to see if another approach can yield reductions in overprescribing.”

The study is considered one of the first to evaluate the efficacy of an informative letter at reducing a potentially inappropriate medical practice. 

Also, in a new study, the team is evaluating high prescribers of the atypical antipsychotic quetiapine (Seroquel). “This intervention uses better data and a redesigned letter to build as much as possible on the first round,” Sacarny noted.

Reference

Sacarny A, et al. Medicare Letters To Curb Overprescribing Of Controlled Substances Had No Detectable Effect On Providers. Health Aff. 2016; 35(3):471-479.

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