Relationship between facility number of clinicians and prescribing intensity of psychotropic medications, opioids, and antibiotics in ambulatory practice

Table 1 Clinician-level^* prescribing intensity for psychiatrists and primary care clinicians across all VA facilities and rate of change associated with 10 additional facility clinicians, 2017

	Percent of Patients on Each Medication
By Psychiatrists	Benzodiazepines		Antipsychotics		Antiepileptics		Antidepressants
%, mean (SD)	11.5	(5.4)	16.4	(4.9)	10.7	(3.8)	48.1	(13.4)
Rate^† (95% CI)	0.89	(0.86, 0.92)	0.93	(0.90, 0.95)	0.94	(0.92, 0.96)	0.93	(0.91, 0.95)
By PCPs	Antibiotics		Opioids		Antiepileptics		Antidepressants
%, mean (SD)	6.4	(2.2)	7.1	(3.1)	6.3	(2.4)	5.9	(2.5)
Rate^† (95% CI)	0.98	(0.97, 0.98)	0.97	(0.97, 0.98)	0.97	(0.96, 0.98)	0.98	(0.97, 0.98)
	Mean Days Supply per Patient
By Psychiatrists	Benzodiazepines		Antipsychotics		Antiepileptics		Antidepressants
Days, mean (SD)	21.1	(11.0)	33.5	(12.9)	18.6	(8.4)	132.8	(48.9)
Rate^† (95% CI)	0.89	(0.86, 0.92)	0.91	(0.88, 0.93)	0.91	(0.88, 0.94)	0.92	(0.90, 0.94)
By PCPs	Antibiotics		Opioids		Antiepileptics		Antidepressants
Days, mean (SD)	1.5	(0.5)	9.1	(5.0)	11.5	(4.9)	11.7	(6.0)
Rate^† (95% CI)	0.97	(0.97, 0.98)	0.97	(0.96, 0.98)	0.97	(0.96, 0.98)	0.97	(0.96, 0.98)

Abbreviations: SD is standard deviation; CI is confidence interval; PCP is primary care physician
^*Clinicians include residents or attendings with at least 11 patients in their patient panel in 2017
^†Estimated by exponentiating 10 times the coefficient of the number of facility clinicians from a multilevel generalized mixed model of prescribing intensity with log link and facilities as random intercepts. If the model did not fit, generalized linear model with robust standard deviation was used to account for within facility correlation

ISSN: 1472-6963