Multiple factors are responsible for driving the complex clinical decision-making process. Things like peer pressure, psychological and social dynamics, as well as exposure to pharmaceutical advertising play a role in a physician’s choice of medication to use on patients suffering from insomnia.
Harvard Medical School conducted new research, which shows a physician’s choice of insomnia drug is based heavily on habit.
These results indicate that physicians and other prescribing practitioners use these specific insomnia drugs almost like a reflex, done mostly out of routine rather than taking into account a patient’s medical history, symptoms, or sensitivities. They may even ignore patient preferences in favor of their preferred insomnia medication or melatonin. It was the clinician’s prescribing pattern, not patient characteristics, that was the primary predictor of which drug would be used with insomnia patients.
This research was based on the review of 1,105 patient medical records, including clinical notes. Results were published in February’s issue of Scientific Reports.
These results show that, like the rest of the human race, physicians are ultimately creatures of habit, notes Andrew Beam, lead author of the study and research fellow at Harvard’s Department of Biomedical Informatics. Dr. Beam reminds readers that doctors may not always be as rational as many people believe.
Approximately $60 billion is spent on insomnia every year in the United States. That number does not even take into account the physical toll the condition takes on sufferers. It is estimated that insomnia actually affects up to 40% of Americans. Still, insomnia is one of the most underdiagnosed and poorly treated conditions that blight the American people.
Dr. Beam added in the report of their findings that choosing the right medication should be based on individual patient needs and characteristics. This is critical to the successful resolution of symptoms, as well as the avoidance of social and psychological consequences related to insomnia.
The two most frequently prescribed insomnia medications, zolpidem and trazodone, were analyzed in this research. Zolpidem is a newer drug with proven recorded efficacy; however, it is associated with several side effects including dizziness and drowsiness the next day. Trazodone is older and often used for depression, but it does not have the efficacy of zolpidem; however, its safety profile is well established.
It is still unclear as to why doctors will choose one drug over another, which was the original driving factor for this research at Harvard. Scientists set out to unravel the driving factors of clinical decision-making.
Researchers analyzed the narrative clinical notes, patient records, and physician prescribing records. They found that a physician who prescribed one drug in the past was three times as likely to prescribe that medication again to other patients.
It was notable that patients who had depression symptoms along with insomnia were more likely to get a prescription for trazodone than insomnia patients who had no symptoms of depression. Researchers note that this particular finding suggests that there are some considerations to patient characteristics in the provider’s medical decision-making.
Furthermore, these findings emphasize the importance of the data contained within electronic medical records, which can yield exceptionally interesting insights into the relationship between patient characteristics and provider medical decision-making with regard to treatment options.
Dr. Zak Kohane, department chair at HMS’s Biomedical Informatics, notes that electronic medical records have played a pivotal role in providing a richness to the information that is immediately available for research. It allows scientists to deconstruct physician behaviors and decision-making habits and put them in context of the patient-provider encounter. This is a good way to approach treatment decisions for more complex conditions.
Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.
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