Posted on Aug 02, 2018, 12 a.m.
Behavioral nudges via letters targeting high prescribers of Seroquel/Quetiapine have lead to a drop in prescriptions of the potent antipsychotic with potentially harmful side effects among the elderly, as published in JAMA Psychiatry.
Results show peer comparison letters led to meaningful persistent decreases in prescriptions without detection of negative effects on patients, according to researchers from Columbia University’s Mailman School Of Public Health. This study provides an example of large scale low cost intervention which yields clinically meaningful long lasting results says Adam Sacarny, PhD.
Conducted using randomized controlled trial targeting 5,055 highest Seroquel prescribing physicians nationwide in the Medicare Part D program, half of the doctors were assigned to treatment arm receiving 3 letters comparing their prescribing practices to that of their peers, the other half receiving placebo letters regarding an unrelated Medicare regulation.
Treatment arm letter stated their prescribing of Quetiapine was high relative to peers and was under review, discussing that it could be appropriate but was concerning for medically unjustified use, and encouraged physicians to review their prescribing patterns. Physicians who received peer comparison letter dropped overall Seroquel prescribing by 11% over 9 months, and 16% over 2 years; new initiations dropped even more 24% over 2 years.
Researchers followed patients who had been treated by the physicians. Patients of the treatment group received 6% fewer days of Seroquel over 2 years. Patients with dementia history experienced a larger reduction of 8% fewer days of Seroquel. There wasn’t any evidence of adverse effects on patients due to the letters, use of the ER, hospitalizations, and mortality was similar for patients of control and treatment physicians.
Particularly among the elderly overprescribing antipsychotic drugs is a persistent problem, results are striking for something as simple as a letter says Dr.Michael Barnett of the Harvard T.H. Chan School of Public Health. Adding the intervention could have implications for nudging physician behavior more broadly.
Researchers are hopefully similar interventions may help to address over prescribing of other drugs such as opioids or target care going against clinical guidelines, saying results showed that with increasing need to address inappropriate prescribing, peer comparison letters targeting high risk medications may provide a way to efficiently create lasting changes.
Materials provided by Columbia University's Mailman School of Public Health.
Note: Content may be edited for style and length.
Adam Sacarny, Michael L. Barnett, Jackson Le, Frank Tetkoski, David Yokum, Shantanu Agrawal. Effect of Peer Comparison Letters for High-Volume Primary Care Prescribers of Quetiapine in Older and Disabled Adults. JAMA Psychiatry, 2018; DOI: 10.1001/jamapsychiatry.2018.1867