Antipsychotic prescribing quality and ethnicity: a study of hospitalized patients in south east London.
ABSTRACT A number of studies have shown qualitative and quantitative differences in prescribing of antipsychotics according to patient ethnicity. Black patients tend, for example, to be prescribed higher doses of antipsychotics than whites. Few studies have controlled for other factors which may influence prescribing practice and confound results. This study sought to determine whether or not ethnicity was associated with antipsychotic polypharmacy, high dosage and antipsychotic costs before and after adjustment for potential confounding. We approached inpatients on acute general psychiatry wards at the Maudsley, Bethlem and Lambeth hospitals in south east London. Prescription details were noted. Subjects were interviewed and social and clinical details were recorded. In all, data on 23 potential confounders were collected.A total of 210 patients were approached of whom 153 agreed to take part. Of the 23 potential confounders, only use of English as a first language and duration of illness differed significantly between blacks and whites. Categorical findings were adjusted for these factors and other potential confounders such as age and gender. Total antipsychotic daily dose was 82.2% of licensed maximum in blacks, and 77.2% in whites (p=0.48). Antipsychotic polypharmacy was seen in 23.2% of blacks and 16.9% of whites (adjusted odds ratio (OR) 1.11; 95% CI, 0.45-2.75). High dose (> 100% of maximum dose) antipsychotic regimens were prescribed to 15.9% of blacks and 16.9% of whites (adjusted OR, 0.71: 95% CI, 0.27-1.90). Mean monthly cost of treatment was significantly higher in blacks than whites (182.79 vs 143.08 British pound; p=0.02; adjusted OR (> 150 British pound/month), 2.45: 95% CI, 1.19-5.08). Prescribing quality was similar for blacks and whites. Black ethnicity was associated with significantly higher mean monthly medication costs.
- Psychiatric Bulletin 01/2000; 24(4):130-132.
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ABSTRACT: This study aimed to examine the extent and type of variation in antipsychotic prescription patterns between African American and Caucasian patients with schizophrenia. Subjects were 2,515 adult Medicaid recipients treated for schizophrenia in 1995 with one of four types of antipsychotic medication (traditional antipsychotics, clozapine, risperidone, or depot antipsychotics). Prescription and mental health service use data were collected from Medicaid claims files for the 12 months following the first filled antipsychotic prescription. Patterns of antipsychotic prescription were compared for African American (N=1,538, 61%) and Caucasian (N=977, 39%) subjects. African American subjects were significantly younger and more likely to receive Supplemental Security Income than were the Caucasian subjects, who received mental health services more continuously. African American subjects were less likely than Caucasian subjects to receive clozapine (8% versus 15%, respectively) and risperidone (25% versus 31%) and more likely to receive depot antipsychotics (26% versus 14%). The likelihood of receiving clozapine or risperidone remained significantly different after demographic and service use characteristics were controlled. This study found ethnic disparities in antipsychotic prescription patterns among a large number of publicly insured clients treated for schizophrenia. Given the rapidly changing pharmacological treatment environment, these findings have significant implications for differential quality of care for African American patients. Future studies employing client and provider characteristics are urgently needed to test alternative explanations for ethnic disparities.American Journal of Psychiatry 05/2002; 159(4):567-72. · 14.72 Impact Factor
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ABSTRACT: This study examined prescribing practices for antipsychotic medications at 13 Veterans Affairs (VA) medical centers and whether patients' sociodemographic characteristics were associated with receiving novel agents. Automated pharmacy data were used to identify 599 patients who had been diagnosed as having schizophrenia and who had received a prescription for an antipsychotic medication after their last discharge from a VA medical center in 1997. Novel antipsychotics were found to have been prescribed for almost half of the patients (47 percent). In logistic regression analysis, significant variations in prescription of novel agents were found among the facilities and among ethnic groups. The results of this study suggest that prescribing practices are influenced by both facility and patient characteristics.Psychiatric Services 12/2001; 52(11):1523-5. · 2.01 Impact Factor