Tracing the Flow of Knowledge

Harpaz‐Rotem, Ilan; Rosenheck, Robert A.

doi:10.1001/archgenpsychiatry.2008.536

Cited by 33 publications

(9 citation statements)

References 20 publications

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“…Even if we combine our findings with those of Hermes et al and Harpaz-Rotem et al [9][10], there is a persistent geographic gradient for utilization and dosing of prazosin for Veterans with PTSD. Demonstration of the pattern of geographical distribution is limited to prazosin and is not reflective of other PTSD pharmacotherapies.…”

Section: Discussionmentioning

confidence: 56%

“…We defined PTSD according to the International Classification of Diseases-9th Revision (ICD-9), using 309.81 as the ICD-9 code. This case definition was used in the original prazosin diffusion article and in several subsequent studies of PTSD prescribing practices in VA [6][7][9][10][11]. Each patient was assigned to a single VHA medical center based on the site of a majority of their PTSD coded encounters.…”

Section: Patients and Facilitiesmentioning

confidence: 99%

“…The distance of each VHA medical center to the Puget Sound VHA medical center in Seattle, Washington, was determined using geocoded address information for each medical center as the reference point. Distances were categorized as 0 miles (including Puget Sound VA Health Care System locations in Seattle and Tacoma, Washington), up to 499 miles, 500 to 999 miles, 1,000 to 2,499 miles, and 2,500 miles or farther from Puget Sound [9][10].…”

Section: Patients and Facilitiesmentioning

confidence: 99%

“…Evidence also reveals that SSRI/SNRIs are prescribed widely throughout the VHA system [6][7][8]; in contrast, the pattern of prazosin use exhibits an interesting pattern of geographical diffusion emanating from the Puget Sound Department of Veterans Affairs (VA) Health Care System in Seattle, Washington [9][10]. In part this could be because prazosin is only recommended as a treatment for traumatic nightmares and not for global PTSD symptoms per se.…”

Section: Introductionmentioning

confidence: 99%

“…In part this could be because prazosin is only recommended as a treatment for traumatic nightmares and not for global PTSD symptoms per se. In 2004, the 1 yr period prevalence of prazosin in Veterans with PTSD was 38 percent among Puget Sound patients, declining to 18 percent at VHA sites within 500 miles, and progressively down to only 2 percent at sites 2,500 miles from Puget Sound [10]. Analyses from fiscal year (FY) 2012 showed that prazosin prescribing rates were generally similar (i.e., 33%) at Puget Sound; in contrast, among sites greater than 2,500 miles away there were substantial gains in utilization, increasing from 2 to 15 percent [9].…”

Section: Introductionmentioning

confidence: 99%

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Geographical diffusion of prazosin across Veterans Health Administration: Examination of regional variation in daily dosing and quality indicators among veterans with posttraumatic stress disorder

et al. 2015

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Abstract-Posttraumatic stress disorder (PTSD) is a highpriority treatment area for the Veterans Health Administration (VHA), and dissemination patterns of innovative, efficacious therapies can inform areas for potential improvement of diffusion efforts and quality prescribing. In this study, we replicated a prior examination of the period prevalence of prazosin use as a function of distance from the Puget Sound Department of Veterans Affairs Healthcare System in Seattle, Washington, where prazosin was first tested as an effective treatment for PTSD and where prazosin use was previously shown to be much greater than in other parts of the United States. We tested the following three hypotheses related to prazosin geographic diffusion: (1) no geographical correlation exists between prazosin use and serotonin reuptake inhibitor/serotonin norepinephrine reuptake inhibitor (SSRI/SNRI) use, (2) an inverse geographic correlation exists between prazosin and benzodiazepine use, and (3) a positive geographical correlation exists between the distance from Puget Sound and the proportion of users treated according to a guideline recommended minimum therapeutic target dose (6 mg/d). Among a national sample of Veterans with PTSD, overall prazosin utilization increased from 5.5% to 14.8% from 2006 to 2012. During this time period, rates at the Puget Sound location declined from 34.4% to 29.9%, whereas utilization rates at locations a minimum of 2,500 miles away increased from 3.0% to 12.8%. Rates of minimum target dosing fell from 42.6% to 34.6% at the Puget Sound location. In contrast, at distances of at least 2,500 miles from Puget Sound, minimum threshold dosing rates remained stable (range: 18.6%-17.7%). No discernible association was demonstrated between SSRI/SNRI or benzodiazepine utilization and the geographic distance from Puget Sound. Minimal threshold dosing of prazosin correlated positively with increased diffusion of prazosin use, but there was still a distance diffusion gradient. Although prazosin adoption has improved, geographic differences persist in both prescribing rates and minimum target dosing. Importantly, these regional disparities appear to be limited to prazosin prescribing and are not meaningfully correlated with SSRI/SNRI and benzodiazepine use as indicators of PTSD prescribing quality.

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Section: Discussionmentioning

confidence: 56%