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Veyej N, Moosa MYH. Prescribing patterns of long-acting injectable antipsychotics in a community setting in South Africa. S Afr J Psychiatr 2022; 28:1809. [PMID: 35812829 PMCID: PMC9257713 DOI: 10.4102/sajpsychiatry.v28i0.1809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Long-acting injectable antipsychotics (LAI – APs) improve adherence to antipsychotics and decrease functional decline in schizophrenia. Yet they are prescribed late, in patients with established functional decline. Although LAI – APs are widely prescribed in South Africa, there is a paucity of research regarding the prescription profile for LAI – APs. Aim This study aimed to describe prescribing practices for LAI – APs at psychiatric clinics. Setting Community psychiatric clinics in South Africa. Methods A retrospective review of the psychiatric files of all patients on LAI – APs attending the clinics over the study period was conducted. Sociodemographic, clinical and pharmacological information regarding the LAI – AP prescribed was extracted from the files. Results A total of 206 charts were examined. The mean age of the study population was 46 (SD ± 12) years. Significantly more patients were male (n = 154; 74.8%), single (n = 184, 89.3%) and unemployed (n = 115; 55.8%) (p < 0.001). Approximately half had a comorbid substance use disorder (47.6%). The most common indication for the prescription of a LAI – AP was non-adherence (66%). Only 9.7% of the patients were prescribed a LAI – AP alone. No significant socio-demographic or clinical characteristic was associated with this prescribing habit. A LAI – AP was prescribed in combination with an oral antipsychotic, mood stabiliser or antidepressant in 53.9%, 44.7% and 7.8% of patients, respectively. Conclusion Long-acting injectable antipsychotics were prescribed mainly following noncompliance with oral antipsychotics and may represent a missed opportunity to prevent functional decline. The high prevalence of LAI – AP polypharmacy has been highlighted.
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Affiliation(s)
- Nabila Veyej
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mahomed Y H Moosa
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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2
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Prescribing Practice in Inpatients Versus Outpatients With Schizophrenia Initiating Treatment With Second-Generation Antipsychotics: A Naturalistic Follow-Up Study. J Clin Psychopharmacol 2016; 36:621-627. [PMID: 27662459 DOI: 10.1097/jcp.0000000000000573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary objective of this study was to investigate whether the choice and dosage of antipsychotic medication differ between patients with schizophrenia starting treatment in an inpatient or outpatient unit. In addition, we investigated whether the reason for the introduction of new antipsychotic medication had an impact on the treatment setting and whether the use of benzodiazepines differed between inpatients and outpatients. METHOD From October 1997 to September 2010, patients with a schizophrenia spectrum disorder according to the International Classification of Diseases, Tenth Revision aged between 18 and 65 years were allocated to a naturalistic drug-monitoring program when starting treatment with a second-generation antipsychotic drug. Psychopathological symptoms were rated at baseline and after 1, 2, 4, and 8 weeks of treatment using the Positive and Negative Syndrome Scale. Inpatients and outpatients were compared with regard to the use of antipsychotics and benzodiazepines. To compare different drugs, chlorpromazine and diazepam equivalents were calculated. RESULTS Lack of efficacy and side effects were the main reasons for initiating new antipsychotic medication. Combined evaluation of all antipsychotic compounds by meta-analysis resulted in a significant effect of the treatment setting, with inpatients receiving higher doses than outpatients. In addition, inpatients were prescribed benzodiazepines more often and in higher doses than outpatients. CONCLUSIONS Both antipsychotics and benzodiazepines were prescribed at higher doses in an inpatient setting. Moreover, benzodiazepines were prescribed more frequently to inpatients. Accordingly, the treatment setting needs to be taken into consideration in treatment recommendations for schizophrenia spectrum disorders.
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Rickles NM, Svarstad BL. Using Medicaid Claims and Dosing Guidelines to Assess the Prescribing and Outcomes of Conventional Antipsychotics. J Pharm Technol 2016. [DOI: 10.1177/875512250301900403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: While newer atypical antipsychotics are considered the treatment of choice for schizophrenia, it is important to study dosing guidelines for conventional antipsychotics as they continue to be used alone or in combination with newer agents for patients who are refractory to treatment with newer agents. Few studies have used Medicaid claims for this purpose, even though they provide a readily available and objective means of assessing dosing in relation to guidelines and outcomes of prescribing. Objective: To examine a new multi-method approach for studying dosing guidelines and outcomes of prescribing in Medicaid recipients receiving conventional antipsychotics. Methods: Data were collected from medical records, Medicaid prescription and hospital claims, and case managers in 8 county-based delivery systems in Wisconsin during a 12-month period in 1989–1990 as a part of a larger naturalistic study. Eligible patients had a primary diagnosis of schizophrenia, a prescription for oral antipsychotics, and no hospitalizations during baseline (first quarter). Results: Of 159 patients, 46.5%, 32.1%, and 21.4% had baseline antipsychotic doses below, above, and within the guidelines, respectively. Patients dosed above the guidelines were 4 times more likely to be hospitalized after baseline (p < 0.05) than those within the guidelines after controlling for adherence, baseline functioning, and past hospitalizations. Further analysis showed that the high-dose/hospitalization relationship was mediated or explained in part by adverse effects. Conclusions: The use of Medicaid claims revealed a substantial amount of prescribing outside of guidelines and an increased risk of hospitalization during the study period. Future trials are needed to compare this methodologic approach with other approaches and to determine whether current dosing patterns and outcomes have changed. This study was made possible through Rickles' National Institute of Mental Health (NIMH) Fellowship in Mental Health Services Research at the University of Wisconsin — Madison. The study obtained data from a larger project supported by NIMH grant MH-43555 to the late Dr. James Greenley and his colleagues at the University of Wisconsin — Madison. Data from this study were presented in March 2000 at the 147th Annual Meeting and Exposition of the American Pharmaceutical Association.
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Affiliation(s)
- Nathaniel M Rickles
- NATHANIEL M RICKLES PharmD PhD BCPP, Assistant Professor, Social and Administrative Sciences Division, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY
| | - Bonnie L Svarstad
- BONNIE L SVARSTAD PhD, Apple Professor of Pharmacy, Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin, Madison, WI
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Rossi G, Frediani S, Rossi R, Rossi A. Long-acting antipsychotic drugs for the treatment of schizophrenia: use in daily practice from naturalistic observations. BMC Psychiatry 2012; 12:122. [PMID: 22909285 PMCID: PMC3573926 DOI: 10.1186/1471-244x-12-122] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 08/01/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Current guidelines suggest specific criteria for oral or long-acting injectable antipsychotic drugs (LAIs). This review aims to describe the demographic and clinical characteristics of the ideal profile of the patient with schizophrenia treated with LAIs, through the analysis of nonrandomized studies. METHODS A systematic review of nonrandomized studies in English was performed attempting to analyze the factors related to the choice and use of LAIs in daily practice. The contents were outlined using the Cochrane methods for nonrandomized studies and the variables included demographic as well as clinical characteristics. The available literature did not allow any statistical analysis that could be used to identify the ideal profile of patients with schizophrenia to be treated with LAIs. RESULTS Eighty publications were selected and reviewed. Prevalence of LAI use ranged from 4.8% to 66%. The only demographic characteristics that were consistently assessed through retrieved studies were age (38.5 years in the 1970's, 35.8 years in the 1980's, 39.3 years in the 1990's, to 39.5 years in the 2000's) and gender (male > female).Efficacy was assessed through the use of various symptom scales and other indirect measurements; safety was assessed through extrapyramidal symptoms and the use of anticholinergic drugs, but these data were inconsistent and impossible to pool. Efficacy and safety results reported in the different studies yielded a good therapeutic profile with a maximum of 74% decrease in hospital admissions and the prevalence of extrapyramidal symptoms with LAIs consistently increased at 6, 12, 18, and 24 months (35.4%, 37.1%, 36.9%, and 41.3%, respectively). CONCLUSIONS This analysis of the available literature strongly suggests that further observational studies on patients with schizophrenia treated with LAIs are needed to systematically assess their demographic and clinical characteristics and the relationships between them and patient outcome.Besides the good efficacy and safety profile of LAIs, health care staff must also take into account the importance of establishing a therapeutic alliance with the patient and his/her relatives when selecting the most appropriate treatment. LAIs seem to be a good choice not only because of their good safety and efficacy profile, but also because they improve compliance, a key factor to improving adherence and to establishing a therapeutic alliance between patients with schizophrenia, their relatives, and their health care providers.
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Affiliation(s)
- Giuseppe Rossi
- U.O. Psichiatria, IRCCS "Centro San Giovanni di Dio" Fatebenefratelli, via Pilastroni 4, Brescia, Italy.
| | - Sonia Frediani
- Centro di Salute Mentale La Badia U.S.L. 11, Empoli, Italy
| | - Roberta Rossi
- U.O. Psichiatria, IRCCS “Centro San Giovanni di Dio” Fatebenefratelli, via Pilastroni 4, Brescia, Italy
| | - Andrea Rossi
- Medical Dept. Eli Lilly Italy, Via Gramsci 731, Sesto Fiorentino (FI), Italy
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Abstract
Antipsychotic polypharmacy refers to the co-prescription of more than one antipsychotic drug for an individual patient. Surveys of prescribing in psychiatric services internationally have identified the relatively frequent and consistent use of combined antipsychotics, usually for people with established schizophrenia, with a prevalence of up to 50% in some clinical settings. A common reason for prescribing more than one antipsychotic is to gain a greater or more rapid therapeutic response than has been achieved with antipsychotic monotherapy. However, the evidence on the risks and benefits for such a strategy is equivocal, and not generally considered adequate to warrant a recommendation for its use in routine clinical practice in psychiatry. Combined antipsychotics are a major contributor to high-dose prescribing, associated with an increased adverse effect burden, and of limited value in helping to establish the optimum maintenance regimen for a patient. The relatively widespread use of antipsychotic polypharmacy identified in cross-sectional surveys reflects not only the addition of a second antipsychotic to boost therapeutic response, but also the use of as-required antipsychotic medication (mainly to treat disturbed behaviour), gradual cross-titration while switching from one antipsychotic to another, and augmentation of clozapine with a second antipsychotic where the illness has failed to respond adequately to an optimized trial of clozapine. This review addresses the clinical trial data and other evidence for each of these pharmacological approaches. Also reviewed are examples of systematic, practice-based interventions designed to reduce the prevalence of antipsychotic polypharmacy, most of which have met with only modest success. Guidelines generally agree that if combined antipsychotics are prescribed to treat refractory psychotic illness, this should be after other, evidence-based, pharmacological treatments such as clozapine have been exhausted. Further, their prescription for each patient should be in the context of an individual trial, with monitoring of the clinical response and adverse effects, and appropriate physical health monitoring.
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Affiliation(s)
- Thomas R E Barnes
- Division of Experimental Medicine,Centre for Mental Health, Imperial College London, Charing Cross Campus, London, UK.
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Predictors of the discharge dosage of an atypical antipsychotic agent among hospitalized, treatment-naive, first-episode psychosis patients in naturalistic, public-sector settings. J Clin Psychopharmacol 2011; 31:10-5. [PMID: 21192136 DOI: 10.1097/jcp.0b013e3182042154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Little is known about determinants of second-generation antipsychotic dosages during initial hospitalization of first-episode psychosis. This study examined potential predictors of dosage of an atypical antipsychotic agent, risperidone, at hospital discharge after initial evaluation and treatment of first-episode nonaffective psychosis in 3 naturalistic, public-sector treatment settings. METHODS The number of psychotropic agents prescribed and discharge antipsychotic dosage were abstracted from the medical record. Demographic and extensive clinical characteristics were assessed through a clinical research study conducted at the 3 sites. One-way analyses of variance, trend tests using specific linear combinations of estimates, and χ² tests assessed for associations between atypical antipsychotic dosage and 5 hypothesized predictors, as well as 12 exploratory variables. RESULTS Among 155 hospitalized first-episode patients, 121 (78.1%) were discharged on risperidone, and subsequent analyses focused on that subset. The mean risperidone dosage among those 121 patients was 4.26 mg; 31 received 1 to 2 mg, 45 received 3 to 4 mg, 37 received 5 to 6 mg, and 8 received more than 6 mg. Analyses suggested that older age at hospitalization, the number of psychotropic agents prescribed, excited symptoms, and premorbid social functioning may be predictors of the discharge dosage. CONCLUSIONS Although several factors emerged, in general, predictors of discharge dosages of second-generation agents, here exemplified by risperidone, in real-world practice settings remain to be clarified. Given the importance of antipsychotic initiation during first hospitalization, future research should test an even broader array of potential predictors.
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Santone G, Bellantuono C, Rucci P, Picardi A, Preti A, de Girolamo G. Patient characteristics and process factors associated with antipsychotic polypharmacy in a nationwide sample of psychiatric inpatients in Italy. Pharmacoepidemiol Drug Saf 2010; 20:441-9. [DOI: 10.1002/pds.2083] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 11/02/2010] [Accepted: 11/05/2010] [Indexed: 11/12/2022]
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Abstract
When clinical psychologists make judgments, are they likely to be correct or incorrect? The following topics are reviewed: (a) methodological advances in evaluating the validity of descriptions of personality and psychopathology, (b) recent findings on the cognitive processes of clinicians, and (c) the validity of judgments and utility of decisions made by mental health professionals. Results from research on clinical judgment and decision making and their relationship to conflicts within the field of clinical psychology are discussed.
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Affiliation(s)
- Howard N Garb
- Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas 78236-5300, USA.
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Ito H, Koyama A, Higuchi T. Polypharmacy and excessive dosing: psychiatrists' perceptions of antipsychotic drug prescription. Br J Psychiatry 2005; 187:243-7. [PMID: 16135861 DOI: 10.1192/bjp.187.3.243] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite extensive research and recommendations regarding the optimal prescription of antipsychotic drugs, polypharmacy and excessive dosing still prevail. AIMS To identify the factors associated with the polypharmacy and excessive dosing phenomena. METHOD We studied 139 patients with schizophrenia, in 19 acute psychiatric units in Japanese hospitals, who were due to be discharged between October and December 2003. We examined patient characteristics, nurses' requests, and psychiatrists' characteristics and perceptions of prescribing practice and algorithms. RESULTS Polypharmacy and excessive dosing were observed in 96 cases. Logistic regression analysis revealed that the use of multiple medications and excessive dosing were influenced by the psychiatrist's scepticism towards the use of algorithms, nurses' requests for more drugs and the patient's clinical condition. CONCLUSIONS Educational interventions are necessary for psychiatrists and nurses to follow evidence-based guidelines or algorithms.
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Affiliation(s)
- Hiroto Ito
- National Institute of Mental Health, Kodaira, Tokyo, Japan.
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Edlinger M, Hausmann A, Kemmler G, Kurz M, Kurzthaler I, Walch T, Walpoth M, Fleischhacker WW. Trends in the pharmacological treatment of patients with schizophrenia over a 12 year observation period. Schizophr Res 2005; 77:25-34. [PMID: 16005382 DOI: 10.1016/j.schres.2005.01.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Revised: 01/20/2005] [Accepted: 01/21/2005] [Indexed: 10/25/2022]
Abstract
In this study we evaluated whether our efforts to promote evidence-based guidelines for the psychopharmacological treatment of patients with schizophrenia have led to measurable changes of treatment practice in our hospital by investigating three primary hypotheses: 1) Polypharmacy has become less common in recent years, 2) Conventional neuroleptics have been replaced by second generation antipsychotics; and 3) Dosing regimes have changed towards lower doses. We have therefore collected data from the clinical records of all in-patients with ICD-9/ICD-10 diagnoses of schizophrenia hospitalized at the Department of Psychiatry of the Medical University Innsbruck in the years 1989, 1995, 1998 and 2001. Data from 1989 to 1998 showed a significant decrease in the use of two or more antipsychotics given simultaneously. Contrary to our hypothesis, there was a significant increase in polypharmacy between 1998 and 2001. The predominant use of second generation antipsychotics became standard in schizophrenia treatment. In this context the decrease of concomitant anticholinergic medication is notable. Doses of conventional antipsychotics like haloperidol as well as doses of risperidone decreased whereas doses of other second generation antipsychotics increased. All in all, the pharmacological management of schizophrenia patients is increasingly in tune with current treatment guidelines.
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Affiliation(s)
- Monika Edlinger
- Department of Biological Psychiatry, Medical University Innsbruck Anichstrasse 35 A-6020, Austria.
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Martínez Granados F, Moñino Martínez C, Pol Yanguas E, Ivorra Cano JM, Villar Malpica JL. Análisis de la correlación entre la calidad de la prescripción de antipsicóticos y el estado clínico en pacientes con esquizofrenia. FARMACIA HOSPITALARIA 2005; 29:95-103. [PMID: 16013931 DOI: 10.1016/s1130-6343(05)73644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The aim of this study is to describe the psychopharmacological aspects of psychiatric practice in a group of schizophrenic patients and to evaluate whether or not practice agrees with treatment guidelines. The study also intends to objectively measure the psychopathological state of patients in order to establish correlation between different pharmacological aspects of treatment and their clinical outcomes. METHOD We have elaborated six recommendations concerning the pharmacological treatment of schizophrenia, taken from several guides, which are based on evidence. The psychopathological state of patients has been evaluated with the Brief Psychiatric Rating Scale (BPRS) and real prescription practice has been analysed. BPRS rates are compared depending on compliance with guidelines. RESULTS More than 60% of patients do not comply with at least 4 of 6 evidence-based recommendations; compliance with recommendations being associated with a minor BPRS punctuation. Differences in BPRS punctuation between compliant and not compliant groups for 3 recommendations (maintenance antipsychotic dosage, antipsychotic association and drugs with a negative effect on cognitive functions), are statistically significant(p < 0,05; bilateral). DISCUSSION Medical practice which closely follows treatment guidelines results in satisfactory clinical outcomes.
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Affiliation(s)
- F Martínez Granados
- Unidad de Hospitalización Psiquiátrica y Centro SocioAsistencial Dr. Esquerdo, San Juan, Spain
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Abstract
In treating schizophrenia there has been a shift in focus, with more attention being paid to early intervention based on the notion that effective treatment at this point can improve outcome. Most of this work has centred on pharmacotherapeutic interventions during the first psychotic break. More recently, attention has turned to the potential value of intervening even earlier, that is during the so-called "prodrome" that has been identified as predating the first psychotic break by as much as 4-5 years. We now have a limited number of published reports addressing this topic and these are reviewed here.
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Affiliation(s)
- Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, Canada.
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Goldman M, Healy DJ, Florence T, Simpson L, Milner KK. Assessing conformance to medication treatment guidelines for schizophrenia in a community mental health center (CMHC). Community Ment Health J 2003; 39:549-55. [PMID: 14713061 DOI: 10.1023/b:comh.0000003015.68850.f2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The feasibility of implementing current medication treatment guidelines in a community mental health clinic was examined in this cross-sectional and retrospective study. Specifically, two issues were addressed: 1) could we identify a set of clinical guidelines whose utilization could be monitored with a routine medical chart review; and 2) were the requisite data for such a review available in the medical records. An examination of three sets of published guidelines revealed 5 specific guidelines that could be operationalized and monitored. Records were reviewed for a random sample of two-thirds of all patients currently diagnosed with schizophrenia and schizoaffective disorder (n = 309). Information was collected from the medical record on patient demographics, diagnosis, duration of illness, symptoms and side effects, and medication information. Rates of conformance to the 5 guidelines ranged from a high of 97% to a low of 43%. The use of current guidelines to improve treatment in community clinics appears to be limited by the deficiencies in the medical record and the structure of the guidelines themselves. Standardized progress notes and computerized prescribing programs will improve conformance, and permit the rapid and accurate assessment of conformance to guidelines in community clinics.
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Affiliation(s)
- Mona Goldman
- Department of Psychiatry, University of Michigan Health System, Ann Arbor 48109-0020, USA
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Owen RR, Fischer EP, Kirchner JE, Thrush CR, Williams DK, Cuffel BJ, Elliott CE, Booth BM. Clinical practice variations in prescribing antipsychotics for patients with schizophrenia. Am J Med Qual 2003; 18:140-6. [PMID: 12934949 DOI: 10.1177/106286060301800402] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few studies have examined the variations among individual physicians in prescribing antipsychotics for schizophrenia. This study examined clinical practice variations in the route and dosage of antipsychotic medication prescribed for inpatients with schizophrenia by 11 different psychiatrists. The sample consisted of 130 patients with a DSM-III-R diagnosis of schizophrenia who had received inpatient care at a state hospital or Veterans Affairs medical center in the southeastern United States in 1992-1993. Mixed-effects regression models were developed to explore the influence of individual physicians and hospitals on route of antipsychotic administration (oral or depot) and daily antipsychotic dose, controlling for patient case-mix variables (age, race, sex, duration of illness, symptom severity, and substance-abuse diagnosis). The average daily antipsychotic dose was 1092 +/- 892 chlorpromazine mg equivalents. Almost half of the patients (48%) were prescribed doses above or below the range recommended by current practice guidelines. The proportion of patients prescribed depot antipsychotics was significantly different at the 2 hospitals, as was the antipsychotic dose prescribed at discharge. Individual physicians and patient characteristics were not significantly associated with prescribing practices. These data, which were obtained before clinical practice guidelines were widely disseminated, provide a benchmark against which to examine more current practice variations in antipsychotic prescribing. The results raise several questions about deviations from practice guidelines in the pharmacological treatment of schizophrenia. To adequately assess quality and inform and possibly further develop clinical practice guideline recommendations for schizophrenia, well-designed research studies conducted in routine clinical settings are needed.
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Affiliation(s)
- Richard R Owen
- Central Arkansas Veterans Healthcare System, Health Services Research & Development Center for Mental Healthcare and Outcomes Research, North Little Rock, AR 72114-1706, USA.
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Affiliation(s)
- Dan Bilsker
- Mental Health Evaluation and Community Consultation Unit, 2250 Wesbrook Mall, University of British Columbia, VGT 1WG, Vancouver BC, Canada.
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