A Simple Letter Helped Curb Overprescribing Of Antipsychotics By Some Doctors : Shots - Health News Researchers found that a simple letter to doctors, focusing on their high prescribing rates, reduced their tendency to give risky antipsychotic drugs to their patients, including some with dementia.

'Dear Doctor' Letters Use Peer Pressure, Government Warning To Stop Overprescribing

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The antipsychotic drug Seroquel is approved to treat people with serious mental illnesses, but frequently, it's also given to people with Alzheimer's disease or other forms of dementia as a sedative. The problem with that - this drug can be deadly for dementia patients according to the FDA. NPR's Ina Jaffe reports on an experiment that got one group of doctors who prescribe Seroquel the most to cut back.

INA JAFFE, BYLINE: What the researchers did seems almost too simple. They identified the roughly 5,000 general care physicians who prescribe Seroquel the most and then sent them some letters.

ADAM SACARNY: We did expect the letters to get their attention.

JAFFE: Because they were pretty strongly worded, says Columbia University's Adam Sacarny who teaches at the Mailman School of Public Health. He's the lead author of the study that was published in JAMA Psychiatry. The letters he says had a couple of different elements, including...

SACARNY: This kind of peer-comparison message. They say that the doctors wrote more prescriptions of Seroquel than their peers.

JAFFE: As much as eight times more in some cases. The federal agency that regulates Medicare was a partner in the study and sent the letters so doctors were also warned, quote, "you have been flagged as a markedly unusual prescriber subject to review by the Center for Program Integrity." After three letters like this, Sacarny and his team track the doctors for two years.

SACARNY: And we found that the doctors cut back prescribing by about 16 percent over that time period, which was a pretty large change.

JAFFE: The decline included both patients who could benefit from Seroquel and patients who could have been harmed by it. Also significant - when doctors stop prescribing Seroquel, they didn't just switch to a different antipsychotic drug. But for dementia patients, antipsychotic drugs aren't the only issue says Dr. Helen Kales, a professor of psychiatry at the University of Michigan.

HELEN KALES: The use of mood stabilizers - that has actually accelerated. So any kind of fixation on one agent, it's maybe winning the battle but not winning the war.

JAFFE: Kales chaired an international committee of experts that just published their recommendations for treating dementia behaviors, like agitation and wandering. The recommendations are in the journal International Psycho Geriatrics.

KALES: The highest-ranked and endorsed treatments are all nonpharmacologic approaches.

JAFFE: Like finding what triggers the patient's behavior or modifying the environment. But Kales says that kind of treatment has been slow to catch on and will never be as easy as dispensing a pill.

Ina Jaffe, NPR News.


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