Files
Abstract
Healthcare spending in the United States has been among the highest of all countries worldwide. One of the big elements of patient care is prescribing. Prescribing cost has been increasing in the United States for the past ten years and reached $329 billion in 2016. Thus, it is important to understand what medications prescribers are relying on in order to potentially decrease the growth rate of prescription cost of the United States. A sequential explanatory mixed methods study with the focus of exploring the existence of small individual formulary phenomenon and a retrospective cross-sectional data analysis were conducted. The mixed methods study was conducted in two phases with the first phase being secondary data analysis using 2015 Medicare prescriber utilization and payment data for Part D prescribers. Prescription medications were ranked in descending order by the number of claims associated with a specific medication. Prescribing breadth was reflected by the number of prescriptions which accounted for the top 80% of total claims. Concentration, or the frequency of prescribing of each drug, was measured by HerfindahlHirschman Index (HHI). The second phase of the mixed method study was 11 semi-structured interviews with active prescribers with the focus on prescribing decision making.The retrospective cross-sectional data analysis employed the 2015 National Ambulatory Medical Care Survey (NAMCS) data. Variation in prescribing was measured using HHI and the number of unique prescriptions identified from all patient visits of each physician. The prescribing behavior was categorized as concentrated when the HHI index was greater than or equal to 1500. Logistic and Poisson regressions, weighted by survey physician weights, were conducted at the physician level to identify significant factors of variation in prescribing.The first phase of mixed method study included a total of 651,736 prescribers, whose results, alongside the results of the second phase, suggest that prescribers rely on a limited number of guideline-recommended cheap medications in regular practice. The number of visits associated with the physician, the ability of the practice to record patients medications and allergies, the ability of the practice to reconcile medication list were significantly associated with variation in prescribing.