Persistence of racial disparities in prescription of first-generation antipsychotics in the USA

Cook, Thomas; Reeves, Gloria; Teufel, James; Postolache, Teodor T.

doi:10.1002/pds.3819

Cited by 31 publications

(19 citation statements)

References 74 publications

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“…Second, NHs with high percentages of black residents may have more residents with cardiovascular comorbid diseases such as diabetes and hypertension . The use of certain antipsychotics may be associated with metabolic disturbances for residents with these comorbidities, and high black facilities may use fewer antipsychotics to reduce the increased adverse risks . This theory could not be examined at the facility level using our data but may be possible using other sources.…”

Section: Discussionmentioning

confidence: 98%

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Inappropriate Antipsychotic Use: The Impact of Nursing Home Socioeconomic and Racial Composition

Fashaw

Chisholm

Mor

et al. 2020

J American Geriatrics Society

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OBJECTIVES Previous research suggests black nursing home (NH) residents are more likely to receive inappropriate antipsychotics. Our aim was to examine how NH characteristics, particularly the racial and socioeconomic composition of residents, are associated with the inappropriate use of antipsychotics. DESIGN This study used a longitudinal approach to examine national data from Long‐Term Care: Facts on Care in the US (http://ltcfocus.org) between 2000 and 2015. We used a multivariate linear regression model with year and state fixed effects to estimate the prevalence of inappropriate antipsychotic use at the NH level. SETTING Free‐standing NHs in the United States. PARTICIPANTS The sample consisted of 12 964 NHs. MEASUREMENTS The outcome variable was inappropriate antipsychotic use at the facility level. The primary indicator variables were whether a facility had high proportions of black residents and the percentage of residents with Medicaid as their primary payer. RESULTS NHs with high and low proportions of blacks had similar rates of antipsychotic use in the unadjusted analyses. NHs with high proportions of black residents had significantly lower rates of inappropriate antipsychotic use (β = −2; P < .001) in the adjusted analyses. Facilities with high proportions of Medicaid‐reliant residents had higher proportions of inappropriate use (β = .04; P < .001). CONCLUSION Findings from this study indicate a decline in the use of antipsychotics. Although findings from this study indicated facilities with higher proportions of blacks had lower inappropriate antipsychotic use, facility‐level socioeconomic disparities continued to persist among NHs. Policy interventions that focus on reimbursement need to be considered to promote reductions in antipsychotic use, specifically among Medicaid‐reliant NHs. J Am Geriatr Soc 68:630–636, 2020

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Section: Discussionmentioning

confidence: 98%

“…26 The use of certain antipsychotics may be associated with metabolic disturbances for residents with these comorbidities, and high black facilities may use fewer antipsychotics to reduce the increased adverse risks. 27,28 This theory could not be examined at the facility level using our data but may be possible using other sources.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate Antipsychotic Use: The Impact of Nursing Home Socioeconomic and Racial Composition

Fashaw

Chisholm

Mor

et al. 2020

J American Geriatrics Society

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“…In addition, our study population was racially diverse (non-white race and minority groups representing 58% vs. 39% in general non-elderly US population) and young (mean age of 24.1 vs. 25.4 in the general US population) (35, 36). We were able to study trends by racial groups, which can be a proxy for differential access to mental health care (37). …”

Section: Discussionmentioning

confidence: 99%

Antipsychotic Medication Use Among Publicly Insured Pregnant Women in the United States

Park

Huybrechts

Cohen

et al. 2017

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Objective Given the increasing use and broadening of indications for antipsychotic medications in the general population, as well as the paucity of information on the safety of this drug class during pregnancy, the study aim was to document patterns of antipsychotic medication use in pregnant women. Method Medicaid Analytic eXtract data (2001–2010) from pregnant women who delivered live-born infants was used. Antipsychotic use at both the class and individual drug level was defined based on dispensed outpatient prescriptions. Users’ characteristics, including mental disorder diagnoses, were described. Temporal trends in use, as well as discontinuation patterns and polytherapy with other psychotropic medications during pregnancy were evaluated. Results Among 1,522,247 pregnancies, the prevalence of atypical antipsychotic use at any time during pregnancy increased three-fold, from .4% to 1.3%, over the 10-year period while the use of typical antipsychotics remained stable around .1%. The increase in atypical use was largely driven by more frequent use in patients with bipolar disorder. Quetiapine and aripiprazole were the most frequently dispensed drugs, and polytherapy with antidepressants (65.2%), benzodiazepines (24.9%), and/or other mood stabilizers (22.0%) was common among women using antipsychotics during pregnancy. More than 50% of women receiving an antipsychotic in the 3 months prior to pregnancy discontinued during pregnancy. Conclusions A growing number of pregnant women in Medicaid are exposed to atypical antipsychotics, frequently in combination with other psychotropic medications. This study highlights the importance of documenting the use and safety of these drugs during pregnancy to inform therapeutic decision making for pregnant women with psychiatric disorders.

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“…(McGinnis et al, 2003;Patel & Bakken, 2010). They are less likely to seek mental health services (Atdjian & Vega, 2005) and once they are in mental health care, they are more likely to discontinue treatment early (Cook, Reeves, Teufel, & Postolache, 2015;Fortuna, Alegria, & Gao, 2010).…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Race, Patient Activation, and Working Alliance: Implications for Patient Engagement in Mental Health Care

Eliacin

Coffing

Matthias

et al. 2016

Adm Policy Ment Health

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This study explored the relationship between race and two key aspects of patient engagementpatient activation and working alliance -among a sample of African-American and White veterans (N=152) seeking medication management for mental health conditions. After adjusting for demographics, race was significantly associated with patient activation, working alliance, and medication adherence scores. Patient activation was also associated with working alliance. These results provide support for the consideration of race and ethnicity in facilitating patient engagement and patient activation in mental healthcare. Minority patients may benefit from targeted efforts to improve their active engagement in mental healthcare.

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Persistence of racial disparities in prescription of first-generation antipsychotics in the USA

Cited by 31 publications

References 74 publications

Inappropriate Antipsychotic Use: The Impact of Nursing Home Socioeconomic and Racial Composition

Inappropriate Antipsychotic Use: The Impact of Nursing Home Socioeconomic and Racial Composition

Antipsychotic Medication Use Among Publicly Insured Pregnant Women in the United States

The Relationship Between Race, Patient Activation, and Working Alliance: Implications for Patient Engagement in Mental Health Care

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