No abstract

When other factors were controlled for, ethnicity was a significant predictor of medication adherence following initiation on an antipsychotic medication, and patients of all ethnicities were most adherent when taking olanzapine, less adherent when taking risperidone, and least adherent when taking haloperidol.

No abstract

Total costs of schizophrenia care associated with olanzapine, risperidone, or haloperidol were similar, but component costs differed. Relative to risperidone or haloperidol, olanzapine may have a higher acquisition cost, but may decrease inpatient costs and be associated with more optimal medication use patterns. Use of risperidone may also increase pharmacy costs and be associated with greater persistence, relative to haloperidol.

Currently, public health emergency preparedness (PHEP) is not well defined. Discussions about public health preparedness often make little progress, for lack of a shared understanding of the topic. We present a concise yet comprehensive framework describing PHEP activities. The framework, which was refined for 3 years by state and local health departments, uses terms easily recognized by the public health workforce within an information flow consistent with the National Incident Management System. To assess the framework's completeness, strengths, and weaknesses, we compare it to 4 other frameworks: the RAND Corporation's PREPARE Pandemic Influenza Quality Improvement Toolkit, the National Response Framework's Public Health and Medical Services Functional Areas, the National Health Security Strategy Capabilities List, and the Centers for Disease Control and Prevention's PHEP Capabilities.

When other factors were controlled for, African Americans were significantly less likely to receive the newer antipsychotics. Among those who received the newer antipsychotics, ethnicity did not affect medication choice.

The authors examined gaps in the use of antipsychotic medications during the one-year period after discharge in an epidemiological sample of 189 first-admission patients with schizophrenia between July 1989 and January 1996. Sixty-three percent of the patients had one or more such gaps, and 51 percent had gaps of 30 days or longer, with an average total time off medication of about seven months. Most gaps occurred soon after discharge, and 73 percent were initiated by the patient. These data, which were obtained before the widespread use of atypical antipsychotic agents, provide a benchmark against which to examine the impact of the newer medications on adherence and continuity of treatment in the critical early stages of schizophrenia.

The findings confirm clinical trial data that for some outcome measures use of antimanics is associated with good outcome in bipolar populations while failure to use these medications regularly was common among subjects with the worst outcomes. In addition, our findings that higher educational attainment and having health insurance predicted regular antimanic use and (for the latter) better outcome underscore the effect of socioeconomic influences while achieving a complete remission seems unrelated to medication use but strongly predicted by age and ethnicity. Finally, the fact that early regular treatment and early high functioning strongly predicted better outcome supports the need for the early diagnosis and treatment of patients with this disorder.