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A7465 - Claims Analysis of Differences in Practice and Focus of Various Physician Specialties that Diagnose and Treat Obstructive Sleep Apnea in the United States
Author Block: M. Ohayon1, J. Profant2, S. Gibson2, C. Milesi3; 1Stanford University, Palo Alto, CA, United States, 2Jazz Pharmaceuticals, Palo Alto, CA, United States, 3EvalStat Research Institute, Palo Alto, CA, United States.
RATIONALE: To characterize physician (MD) specialties that diagnose and treat patients with obstructive sleep apnea (OSA) and assess differences in practice, according to United States (US) healthcare claims.
METHODS:A retrospective analysis of United States (US) healthcare claims from the Symphony Health Solutions Integrated Dataverse database was conducted. These claims contain patient-level data from physician practices, pharmacies, and hospitals linked by unique patient identifiers (Health Insurance Portability and Accountability Act compliant) for a broad longitudinal view of healthcare delivery and patient usage patterns. Claims from July 2010 through March 2015 were analyzed and patients with ≥1 diagnostic code for OSA were identified. OSA patient claims were further analyzed to assess demographics, comorbidities, and device and stimulant (traditional stimulants and wake-promoting agents [WPAs]) utilization. In this analysis, traditional stimulants were amphetamines and methylphenidate; WPAs were modafinil and armodafinil. Estimated dataset capture: 73% of prescription activity, 55% of medical (physician offices, clinics) claims, and 25% of hospital activity in the US.
RESULTS: In the 4.75-year period, 12.4 million patients with OSA were identified. Pulmonologists, primary care physicians (PCPs; general practice, family practice, internal medicine), neurologists, and sleep medicine specialists accounted for the majority of diagnosis, device treatment, and drug treatment of OSA. Pulmonologists were the primary diagnosing specialty for 44% of patients with OSA, followed by PCPs (21%), neurologists (12%), and sleep medicine specialists (9%). Specialties accounting for the majority of positive airway pressure (PAP) devices, oral appliances, and surgery were pulmonologists (36%), PCPs (32%), neurologists (9%), and sleep medicine specialists (8%). Specialties accounting for stimulant prescriptions included psychiatrists (36%), PCPs (30%), neurologists (11%), pulmonologists (10%), and sleep medicine specialists (4%). Time from continuous PAP device treatment initiation to stimulant use varied from 1 to 6 months across specialties with earlier initiation reported for PCP’s and psychiatrists.
CONCLUSIONS: Although pulmonologists accounted for the largest portion of OSA diagnosis and device/surgery treatment, they were not high prescribers of stimulants in OSA. PCPs were equally represented across diagnosis, device/surgery treatment, and stimulant prescribing in OSA. It appeared that PCPs provided the entire continuum of care for many patients with OSA. Psychiatrists were not involved in diagnosis or device/surgery treatment of OSA, but they accounted for the most prescribing of stimulants. PCPs and psychiatrists apparently added stimulant therapy sooner than other specialties. Limitations of this research include the retrospective study design, lack of confirmed prescribing indications for medication claims, and potential bias related to sampling error.