Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

• Published in: Journal of general internal medicine : JGIM 2016-02, Vol.31 (2), p.164-171
• Main Authors: Ong, Mei-Sing, Olson, Karen L., Cami, Aurel, Liu, Chunfu, Tian, Fang, Selvam, Nandini, Mandl, Kenneth D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Benzodiazepines; Benzodiazepines - administration & dosage; Cohesion; Controlled Substances - administration & dosage; Databases, Factual; Drug Prescriptions - statistics & numerical data; Female; Health care; Humans; Inappropriate Prescribing - prevention & control; Inappropriate Prescribing - statistics & numerical data; Internal Medicine; Interprofessional Relations; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Original Research; Overdose; Patient Care Team - organization & administration; Patient Care Team - statistics & numerical data; Patients; Practice Patterns, Physicians' - statistics & numerical data; Prescription Drug Overuse - prevention & control; Prescription Drug Overuse - statistics & numerical data; Professional relationships; Retrospective Studies; Social networks; Social organization; Social Support; United States; Young Adult
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-015-3470-8

ABSTRACT Background Prescription benzodiazepine overdose continues to cause significant morbidity and mortality in the US. Multiple-provider prescribing, due to either fragmented care or “doctor-shopping,” contributes to the problem. Objective To elucidate the effect of provider professional relationships on multiple-provider prescribing of benzodiazepines, using social network analytics. Design A retrospective analysis of commercial healthcare claims spanning the years 2008 through 2011. Provider patient-sharing networks were modelled using social network analytics. Care team cohesion was measured using care density , defined as the ratio between the total number of patients shared by provider pairs within a patient’s care team and the total number of provider pairs in the care team. Relationships within provider pairs were further quantified using a range of network metrics, including the number and proportion of patients or collaborators shared. Main Measures The relationship between patient-sharing network metrics and the likelihood of multiple prescribing of benzodiazepines. Participants Patients between the ages of 18 and 64 years who received two or more benzodiazepine prescriptions from multiple providers, with overlapping coverage of more than 14 days. Results A total of 5659 patients and 1448 provider pairs were included in our study. Among these, 1028 patients (18.2 %) received multiple prescriptions of benzodiazepines, involving 445 provider pairs (30.7 %). Patients whose providers rarely shared patients had a higher risk of being prescribed overlapping benzodiazepines; the median care density was 8.1 for patients who were prescribed overlapping benzodiazepines and 10.1 for those who were not ( p