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The Impact of Provider Networks on the Co-Prescriptions of Interacting Drugs: A Claims-Based Analysis

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Abstract

Introduction

Multiple provider prescribing of interacting drugs is a preventable cause of morbidity and mortality, and fragmented care is a major contributing factor. We applied social network analysis to examine the impact of provider patient-sharing networks on the risk of multiple provider prescribing of interacting drugs.

Methods

We performed a retrospective analysis of commercial healthcare claims (years 2008–2011), including all non-elderly adult beneficiaries (n = 88,494) and their constellation of care providers. Patient-sharing networks were derived based on shared patients, and care constellation cohesion was quantified using care density, defined as the ratio between the total number of patients shared by provider pairs and the total number of provider pairs within the care constellation around each patient.

Results

In our study, 2% (n = 1796) of patients were co-prescribed interacting drugs by multiple providers. Multiple provider prescribing of interacting drugs was associated with care density (odds ratio per unit increase in the natural logarithm of the value for care density 0.78; 95% confidence interval 0.74–0.83; p < 0.0001). The effect of care density was more pronounced with increasing constellation size: when constellation size exceeded ten providers, the risk of multiple provider prescribing of interacting drugs decreased by nearly 37% with each unit increase in the natural logarithm of care density (p < 0.0001). Other predictors included increasing age of patients, increasing number of providers, and greater morbidity.

Conclusion

Improved care cohesion may mitigate unsafe prescribing practices, especially in larger care constellations. There is further potential to leverage network analytics to implement large-scale surveillance applications for monitoring prescribing safety.

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Author information

Authors and Affiliations

  1. Computational Health Informatics Program, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Mei-Sing Ong, Karen L. Olson, Laura Chadwick & Kenneth D. Mandl

  2. Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia

    Mei-Sing Ong

  3. Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA

    Karen L. Olson, Laura Chadwick & Kenneth D. Mandl

  4. HealthCore Inc., Alexandria, VA, USA

    Chunfu Liu

  5. Center for Biomedical Informatics, Harvard Medical School, Boston, MA, 02115, USA

    Mei-Sing Ong & Kenneth D. Mandl

Authors
  1. Mei-Sing Ong
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  2. Karen L. Olson
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  3. Laura Chadwick
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  4. Chunfu Liu
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  5. Kenneth D. Mandl
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Corresponding author

Correspondence to Mei-Sing Ong.

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Funding

This work is supported by Grant R21GM107645 and R01GM104303 from the National Institute of General Medical Sciences, National Institutes of Health (NIH). M-SO is supported by a fellowship from the National Health and Medical Research Council, Australia (APP1052871) and the National Institutes of Health (T15LM007092). The funding bodies played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Conflict of interest

Mei-Sing Ong, Karen L. Olson, Laura Chadwick, Chunfu Liu, and Kenneth D. Mandl have no conflicts of interest that are directly relevant to the content of this manuscript.

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Ong, MS., Olson, K.L., Chadwick, L. et al. The Impact of Provider Networks on the Co-Prescriptions of Interacting Drugs: A Claims-Based Analysis. Drug Saf 40, 263–272 (2017). https://doi.org/10.1007/s40264-016-0490-1

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  • DOI: https://doi.org/10.1007/s40264-016-0490-1

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