Finding Better Doctors by Tracking Prescribing Habits

When you need a prescription drug, often your doctor has a choice. What’s best for one patient with your condition might not be best for you-choosing the best drug is a matter of problem-solving, of matching a person’s variables-age, gender, allergies, other health issues, etc.-with the drug most likely to provide benefit with minimal risk of side effects.

But as investigative health journalists Tracy Weber and Charles Ornstein point out in a Los Angeles Times commentary, “For most of us, evaluating a doctor’s prescribing habits is just about impossible. Even doctors themselves have little way of knowing whether their drug choices fall in line with those of their peers.”

How can you know, for example, if a doctor generally prefers expensive brand-name drugs when generics might be an equally suitable choice? How do you know if a doctor remains current with clinical trials and the latest drug information?

Doctors are seldom monitored, the writers note, to see whether they are prescribing appropriately. Not that it’s easy-there’s no consensus of what good prescribing is.

There’s a lot of bad, that’s for sure. Antipsychotics, for example, treat severe psychiatric conditions such as schizophrenia. But many doctors prescribe them as a sedative for older patients with dementia, even though they come with a “black box” warning of increased risk of death for these patients. Such alerts are prominent on drug packaging in order to communicate danger.

Lots of drugs are dangerous for elderly patients because they increase the risk of dizziness, fainting and falling, among other things, and usually there are alternatives. But that doesn’t stop some doctors for prescribing them inappropriately.

Opioids, powerful painkillers, are another category of widely misused, abused and overused drugs-see our blog, “FDA to Hold Hearings on Misuse of Powerful Pain Pills.”

Weber and Ornstein, who, as reporters for the public interest organization ProPublica, were instrumental in Dollars for Docs, that site’s tool for tracking how much pharmaceutical companies pay health-care providers to tout their wares, are eager to remove the shroud of secrecy around the prescribing habits of doctors.

They needed to quantify the problem, so they turned to the companies that purchase prescription records from pharmacies and sell them back to drug companies that use them for marketing and sales purposes. The data miners declined to sell-at any price-to the reporters. So they turned to Medicare and its 32 million seniors and disabled people who account for 1 in 4 prescriptions written every year.

After filing a Freedom of Information Act for the prescribing data and months of negotiation with officials, they got a list of the drugs prescribed by every health professional to enrollees in Medicare’s prescription drug program, Part D.

“What we found was disturbing,” they report. “Although we didn’t have access to patient names or medical records, it was clear that hundreds of physicians across the country were prescribing large numbers of dangerous, inappropriate or unnecessary drugs. And Medicare had done little, if anything, about it.”

One Miami psychiatrist wrote 8,900 prescriptions in 2010 for powerful antipsychotics for patients older than 65, including many with dementia. An Oklahoma doctor routinely prescribed an Alzheimer’s drug for younger patients who didn’t have the disease but whom, he believed, were helped by the drug to calm the symptoms of autism and other developmental disabilities, never mind that there’s no science to support this idea.

Weber and Ornstein found many doctors who had been charged with crimes, convicted and disciplined by state medical boards or terminated from state Medicaid programs for the poor. Still, nearly all of them remained eligible to prescribe for Medicare patients.
“If you or a loved one were a patient of one of these doctors,” they ask, “wouldn’t you want to know this?”

They’ve compiled the data into an online database called Prescriber Checkup so you can look up a doctor’s prescribing patterns and compare it with those of other doctors.

The project is in its infancy, so it doesn’t say if your doctor is doing something wrong, but it enables you to formulate important questions: Why does your doctor choose a drug few other seldom do? Does your doctor favor expensive brand-name drugs when less expensive generics are available? Has your doctor been paid to give promotional talks for drug makers?

The writers hope the new tool will be as useful to doctors as patients. They hope practitioners will compare themselves to their peers and to those they admire. They hope clinics will see how their staffs stack up. They hope researchers will track patterns and learn something helpful about why doctors prescribe the way they do.

“In the meantime,” they conclude, “arming yourself with prescribing information allows you to be more active in your health care, or that of an aging or disabled loved one.”

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