015 - The association of prescriber prominence in a shared-patient physician network with their patients receipt of risky drug combinations

Objective: To study the association between a prescribing physician's position in a physician shared-patient network and their patients' receipt of risky drug combinations.

Data Sources: All medical encounters in Medicare fee-for-service for Ohio-residing beneficiaries were used to form a shared-patient network of physicians based in Ohio, and Part D prescription drug events for beneficiaries receiving opioids, benzodiazepines, or non-benzodiazepine sedative hypnotics (sedative hypnotics) in 2014 prescribed by these physicians.

Study Design: In this retrospective, observational study we assigned patient prescription receipt to time-varying drug states and linked each drug state transition to a 'responsible' prescribing physician. Outcomes of interest include transitions across drug states, particularly those resulting in combinations of increased risk (e.g., a benzodiazepine or sedative hypnotic with an opioid), and patients' time to discontinuation of overlapping prescriptions of an opioid, benzodiazepine, and sedative hypnotic.

Data Collection/Extraction Methods: An informal physician network (not restricted to a hospital or a health system) was constructed based on sharing patients between physicians reflected in face-to-face visits in Medicare claims. Transitions of risky drug states were related to characteristics of a prescriber's physician network position and compared between primary care physicians (PCPs) and specialists.

Principal Findings: Among beneficiaries receiving none of the three risky drug groups, patients seeing physicians with higher closeness centrality (shorter average path lengths to other physicians through the network) were less likely to transition to two or three risky drugs (OR of 2-drug = 0.923, 95% CI: [0.907, 0.939], p < 0.001; OR of 3-drug = 0.785, 95% CI: [0.657, 0.938], p = 0.008); and they were 4.4% more likely to discontinue overlapping prescriptions of an opioid, benzodiazepine, and sedative hypnotic (95% CI: [1%, 8.9%], p = 0.047). Compared to PCPs, psychiatrists appeared more likely to prescribe risky drug combinations, and their patients were less likely to discontinue overlapping three-drug prescriptions.

Conclusions: Characterizing physicians' prescribing behavior related to their position in shared-patient networks may reveal strategies for optimizing network-based interventions to improve prescribing quality.

Polypharmacy

Physician shared-patient network

Network centrality

Transition matrix

Risky prescribing

State-space model 

Expert

Knowledge

International Conference on Health Policy Statistics 2023