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 The doctors in the study were all writing far more prescriptions for
drugs like opioid painkillers than doctors in similar specialties
practicing nearby - but the letters didn't lead to changes in
prescribing.
Still, the study's lead author said the results will help
researchers who are studying ways to get doctors to pay attention.
"I think if there is a way to make these letters effective it may be
one tool in the arsenal to curb the high rate of opioid deaths,"
said Adam Sacarny, of the Mailman School of Public Health at
Columbia University in New York City.
The use and abuse of opioid pain relievers - like Vicodin and
OxyContin - have risen dramatically since the late 1990s, with
overdose death rates quadrupling between 1999 and 2014, the
researchers write in Health Affairs.
They point out that seniors are often prescribed benzodiazepines or
"benzos" - like Xanax and Valium - for long periods of time, but
these drugs can increase their risk for falls.
Previous research on the effectiveness of letters has found that
comparisons to peers can encourage doctors to vaccinate their
patients and people to pay their taxes, Sacarny told Reuters Health.
To see if letters could do the same for the overprescription of
addicting drugs, the researchers used 2011-2013 data from Medicare,
the joint federal and state health insurance program for seniors and
the disabled.
They identified 1,525 outlier healthcare providers prescribing
Schedule II controlled substances, which carry the potential for
abuse and dependence, at much higher rates than their peers. The
providers were prescribing under the program's prescription program
known as Medicare Part D.
An average outlier provider was responsible for 406 percent more
prescription drug fills than comparable peers, who were matched by
state and specialty.
About 60 percent of the providers were general practitioners.
Another 20 percent were nurse practitioners, and only 20 percent
were specialists.
In 2013, the average outlier provider was each tied to about 1,444
Schedule II prescriptions, which adds up to almost $200,000.
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The outliers were randomly assigned to two groups. In September
2014, providers in one group received letters from the Centers for
Medicare and Medicaid Services (CMS) informing them of how much more
they were prescribing addicting drugs in relation to their peers
across the state and nation.
After 90 days, there were no significant differences in prescribing
patterns between the group that received the letter and the group
that didn't.
It's possible the letters didn't reach the providers or that the
letters just weren't effective, according to the research team,
which included people from CMS in Baltimore, the Massachusetts
Institute of Technology in Cambridge and the White House Social and
Behavioral Sciences Team in Washington, D.C.
Sacarny said a new trial is looking to see whether letters can
affect the prescribing of the antipsychotic medicine quetiapine -
marketed as Seroquel by AstraZeneca. The letters in the new trial
will be sent several times and will emphasize the negative
consequences of overprescribing.
SOURCE: http://bit.ly/1U0amxq Health Affairs, online March 7, 2016
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