The Effect of Informative Letters on the Prescription and Receipt of Seroquel

NCT02467933 | Completed

• 1 other identifier: JPAL-LETTERS-SEROQUEL
• Study Type: interventional
• Target: 5,055
• Locations: 0 countries
• Sites: N/A

Brief Summary

Abusive prescribing exposes patients to unnecessary health risks and results in wasteful public expenditures. This study will evaluate an innovative approach to fighting abusive prescription: sending letters to suspected inappropriate prescribers warning them that they are outliers compared to their peers and have been flagged for review. The study will target high prescribers of Seroquel (Quetiapine), an atypical antipsychotic. Using claims data, the investigators will assess the effect of the letters on prescribing of Seroquel, receipt of Seroquel by patients, substitution behavior by prescribers and patients, and health outcomes of patients.

Conditions

Economics; Fraud; Delivery of Health Care; Health Expenditures; Centers for Medicare and Medicaid Services (U.S.)

Outcome Measures

Primary Outcomes (1)

• 30-day equivalent prescribing of Seroquel treatments

  The prescribing of Seroquel over the 9 months following the initial sending of the letters. Prescribing is defined as the total "days supply" of Seroquel attributed to the prescriber, expressed in "30-day equivalents" i.e. divided by 30.

  9 months

Secondary Outcomes (3)

• 30-day equivalent prescribing of Seroquel treatments

  3 months

• 30-day equivalent prescribing of Seroquel treatments

  6 months

• 30-day equivalent prescribing of Seroquel treatments

  1 year

Study Arms (2)

Placebo

PLACEBO COMPARATOR

The placebo arm receives a placebo letter unrelated to Seroquel

Other: Placebo letter

Informative Letter

EXPERIMENTAL

The interventional arm prescribers receive an initial informative letter (called a comparative billing report or peer activity report) followed by 2 followup informative letters at approximately 3 month intervals.

Other: Initial Informative letter; Other: Followup Informative Letter

Interventions

Placebo letter OTHER

The placebo letter describes a new rule in Medicare that requires prescribers to enroll in Medicare

Placebo

Initial Informative letter OTHER

The intervention is a letter that describes the Seroquel prescribing activity of the individual in comparison to a peer group of similar prescribers. It highlights the fact that the prescriber's activity is highly unlike her peers.

Informative Letter

Followup Informative Letter OTHER

The followup informative letter is identical to the initial informative letter except it provides an update on more recent prescribing rather than a description of earlier prescribing.

Informative Letter

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• General care practitioner
• Outlier with respect to the count of Seroquel prescription drug treatments relative to peer group of prescribers in 2013 and 2014
• Outlier with respect to the count of Seroquel 30-day equivalent prescription drug treatments relative to peer group of prescribers in 2013 and 2014

You may not qualify if:

• Deceased

Sponsors & Collaborators

• Abdul Latif Jameel Poverty Action Lab: lead
• Centers for Medicare and Medicaid Services: collaborator
• General Services Administration (GSA): collaborator

Related Publications (1)

• Sacarny A, Barnett ML, Le J, Tetkoski F, Yokum D, Agrawal S. Effect of Peer Comparison Letters for High-Volume Primary Care Prescribers of Quetiapine in Older and Disabled Adults: A Randomized Clinical Trial. JAMA Psychiatry. 2018 Oct 1;75(10):1003-1011. doi: 10.1001/jamapsychiatry.2018.1867.

  PMID: 30073273 DERIVED

Related Links

• American Economic Association Randomized Controlled Trials Registry Entry

Study Officials

• Adam Sacarny, PhD

  Columbia University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 8, 2015
• First Posted: June 10, 2015
• Study Start: April 1, 2015
• Primary Completion: January 1, 2016
• Study Completion: April 1, 2017
• Last Updated: August 9, 2021

Record last verified: 2021-08