HealthDay News — Letters targeting high prescribers of quetiapine (Seroquel), an antipsychotic with potentially harmful side effects in the elderly, significantly reduces the number of prescriptions for patients in the Medicare program, according to a study published online August 1 in JAMA Psychiatry.

Adam Sacarny, PhD, from Columbia University in New York City, and colleagues randomized (1:1) the 5055 highest-volume primary care prescribers of quetiapine in 2013 and 2014, approximately 5% of all primary care prescribers of quetiapine, to receive a placebo letter or 3 peer comparison letters stating that their quetiapine prescribing was high relative to their peers. 

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The researchers found that the 5055 prescribers consisted of general practitioners (4.6%), family medicine (48%), and internal medicine (47.4%). The vast majority (82.2%) were male. Over 9 months, the treatment arm prescribed 11.1% fewer quetiapine days per prescriber vs the control arm (P<.001; adjusted difference, −319 days; P<.001), which persisted over 2 years (15.6% fewer days; P<.001). Patients in the treatment arm received 3.9% fewer days of quetiapine from all prescribers over 9 months (P<.001), with a larger decrease among patients with low-value vs guideline-concordant indications (P=.01) for tests where effects were equal for both patient groups). There was no evidence of substitution to other antipsychotics, and nine-month mortality and hospital use were similar between the groups.

“Behavioral nudge interventions can raise the quality of prescribing, but research is still needed on how to most precisely target unsafe prescribing behavior,” the authors write.

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