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Organizational Factors Influence on Mental Health Prescribing Behaviors at Community-Based Outpatient Clinics
Mohr DC, Burgess JF, Lee AF, Nealon Seibert M, Bauer MS. Organizational Factors Influence on Mental Health Prescribing Behaviors at Community-Based Outpatient Clinics. Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 14; Minneapolis, MN.
Objectives: We examined organizational factors influence on provider prescribing behavior across different mental health conditions with varying levels of evidence. While social aspects of diffusion have been widely noted, limited research has examined collections of organizations providing similar services that are administratively linked together.
Methods: : The dependent variable was a percentage of the total number of aripiprazole prescriptions per the total number of second generation antipsychotic (SGA) prescriptions at 460 community-based outpatient clinic (CBOC) in 2005. Three conditions were selected based on year of FDA approval for the agent for treating conditions: schizophrenia (2002), bipolar disorder (2005), and PTSD (not approved). Predictor variables included geographic, administrative, and staffing factors. Patient socio-demographic characteristics and comorbidities were summarized at a clinic level. A Poisson model was used for each of the three conditions and a combined model.
Results: Greater aripiprazole use across mental health conditions was related to medical center utilization rate per .1 increase (RR 1.15 - 1.77), on-site pharmacist (RR = 1.33 - 1.58), urban area, and CBOC size (1.29 - 1.67) were positively related to prescribing rates. Having multiple psychiatrists in a CBOC was positively associated with greater utilization for bipolar disorder patients (RR = 1.30) and PTSD patients (RR = 1.34); telehealth was negatively associated with use in PTSD (RR = .73), but positively associated with use in schizophrenia (RR = 1.21); CBOC distance from the medical center was associated with greater aripiprazole use for bipolar disorder (RR = 1.17) In a combined model, prescribing for schizophrenia was higher than bipolar disorder (RR = .82) and PTSD (RR = .85).
Implications: Strong effects were found for administrative factors, such as the medical center utilization, on outpatient clinic prescribing rates. Staffing factors, such as pharmacists and psychiatrists, had a positive influence. Geographic characteristics, such distance and state boundaries, had a lesser or non-significant effect. The direction of the effect was generally consistent across mental health conditions. Established FDA approval appeared to lead to greater prescribing as well.
Impacts: Prescribing behavior is strongly influenced by both administrative and social effects within a healthcare system. Future research should explore how administrative and social aspects may influence other types of provider behaviors and how FDA approval status influences prescribing patterns.