LB-OR02-5 Patterns of Prescribing of Weight Loss Medications in a Large Cohort of Adults

Program: Late-Breaking Abstracts
Session: LB-OR02-Late-Breaking Oral Session- Clinical

Sunday, April 3, 2016: 11:30 AM-1:15 PM
Presentation Start Time: 12:30 PM
Room 210 (BCEC)
Daniel H. Bessesen, MD1, Emily McCormick, MPH2, David R. Saxon, MD3, Michael Horberg, MD4, Matthew Daley, MD5, Caryn Oshiro, PhD6, Corinna Koebnick, MSc7, David Arterburn, MD, PhD8, Nancy Sherwood, PhD9, Gregory Nichols, PhD10 and Deborah Rohm Young, PhD11
1University of Colorado School of Medicine, Anschutz Medical Campus, Denver, CO, 2Denver Health Medical Center, Denver, CO, 3University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 4Mid-Atlantic Permanente Research Inst,, Rockville, MD, 5Inst for Health Research, Kaiser Permanente Colo,, Denver, CO, 65Kaiser Permanente, Center for Health Research Hawaii, Honolulu, HI, 7Kaiser Permanente So Calif,, South Pasadena, CA, 8Group Health Research Institute, Seattle, WA, 9HealthPartners Institute for Education and Research, Minneapolis, MN, 10Kaiser Permanente Center for Health Research, Portland, OR, 11Kaiser Permanente So Calif,, Pasadena, CA
Guidelines endorse the consideration of weight loss medications in the treatment of patients with a BMI>30 kg/m2, or those with a BMI between 27-30 kg/m2 and a weight related comorbidity.  Existing data suggest that few eligible patients actually fill a prescription for a weight loss medication.   

Prescribing patterns of weight loss medications were assessed using data from EHRs in a cohort of 2,262,508 eligible adult patients receiving care over the period of 2009-13 through one of 8 integrated care systems in the Patient Outcomes Research to Advance Learning (PORTAL) network, which is one of 13 Patient Centered Outcomes Research Institute (PCORI) funded Clinical Data Research Networks (CDRNs). Sites within PORTAL participating in this analysis include Kaiser Permanente regions (Northwest, Hawaii, Southern California, Colorado, and Mid-Atlantic States), Group Health Cooperative (Washington), HealthPartners (Minnesota and Wisconsin) and Denver Health.  Subjects were > 18 yrs old and had at least 1 yr of continuous membership in their health plan. Data were available on subject’s gender, race, ethnicity, baseline BMI, co-morbid conditions, number of prescriptions filled over the period of observation, prescribing provider and the medication.

Only 1.0% (23,162) of eligible patients filled a prescription for a weight loss medication over the study period.  Practice variation was seen with 1.8% of eligible patients receiving a prescription in one system while only 0.4% received a prescription in another.  The most commonly prescribed medication was phentermine accounting for 77.3% (160,050) of all prescriptions.  Diethypropion (16.0%), Phendimetrazine (7.4%) and orlistat (4.5%) were less commonly prescribed.  Marked practice variation was also observed with orlistat accounting for 11.6% of prescriptions filled at one site and only 0.1% of prescriptions at another.  There was a gradual and steady increase in the number of weight loss prescriptions filled from 37,277 in 2009 to 48,816 in 2013 (the cohort size did not change). The data suggested patients were not using these medications continuously as there was only an average of 8.9 fills per patient over the 4 yrs examined (range 3.7-12.9 across sites).  Prescriptions were written by a total of 3488 providers. Providers writing 21 or more prescriptions over the period of study accounted for only 30.8% of the total pool of prescribing providers although this group wrote 93.3% of the total number of prescriptions filled. 

Despite guidelines advocating the use of weight loss medications in obese patients, very few appear to be receiving this treatment option. A small number of providers write a vast majority of the prescriptions written for these medications.  There remain many questions about why this situation exists and the effectiveness of weight loss medications in clinical practice.

Disclosure: DHB: data safety monitoring board, Enteromedics Inc. Nothing to Disclose: EM, DRS, MH, MD, CO, CK, DA, NS, GN, DR

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Sources of Research Support: Patient Centered Outcomes Research Institute