Real-World Pharmacotherapy with Novel Antipsychotics

Fichtner, Christopher G.; Luchins, Daniel J.; Malan, Randy; Hanrahan, Patricia

doi:10.1097/00131746-199901000-00005

Cited by 4 publications

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“…Patients’ charts did not provide enough information regarding rationale for physicians’ medication strategies, and given that cases are often seen by a number of physicians, there is little evidence of continuity in medication use. For example, one study found that nearly half of patients given risperidone in a State hospital were taken off their medication within 15 days after discharge by their outpatient physician (Fichtner et al 1999), a problem also noted by physicians participating in our focus groups.…”

Section: Discussionmentioning

confidence: 91%

"Real World" Atypical Antipsychotic Prescribing Practices in Public Child and Adolescent Inpatient Settings

Pappadopulos¹,

Jensen²,

Schur³

et al. 2002

Schizophrenia Bulletin

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This article examines the factors that influence antipsychotic use among youth treated in public inpatient facilities. By combining data from 11 focus groups, a survey of 43 researchers and clinicians, and a chart review of 100 closed patient charts, we investigated the interplay between physicians' and staff members' perceptions of problems related to antipsychotic prescribing, their beliefs concerning optimal approaches, their actual recorded prescribing behaviors, and the discrepancies between their beliefs and their recorded practices. We discovered that antipsychotics are prescribed broadly to treat a variety of conditions, including nonpsychotic disorders among children in public inpatient facilities. Despite overall expert consensus regarding "best practices," physicians described systemic obstacles that prevent the application of these practices, and our data confirmed that best practices are not always followed. Future research should be done with this patient population and should investigate the factors that influence antipsychotic use among inpatient youth.

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Section: Discussionmentioning

confidence: 91%

"Real World" Atypical Antipsychotic Prescribing Practices in Public Child and Adolescent Inpatient Settings

Pappadopulos¹,

Jensen²,

Schur³

et al. 2002

Schizophrenia Bulletin

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“…Naturalistic follow-up studies 6-8 find patients with psychotic illnesses changing medications at rates inconsistent with optimal care, with some receiving no medications for extended periods of time. 5,8 To investigate, describe, and begin to quantify the magnitude of this problem, we studied patients discharged from state hospitals in Illinois while taking risperidone during the first year of the medication's commercial availability. By and large, this is a population of patients with severe mental illness and low socioeconomic status.…”

mentioning

confidence: 99%

Discontinuity of Outpatient Antipsychotic Pharmacotherapy: Risperidone Maintenance after Hospitalization

Malan

Luchins

Fichtner

et al. 2001

Journal of Pharmacy Technology

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The new atypical antipsychotic medications represent major advances in the treatment of schizophrenia and other psychoses, 1-3 and the data supporting their cost-effectiveness appear promising. 4 However, the promise of improved clinical and pharmacoeconomic outcomes can be undercut by real-world problems in continuity of care in the delivery of mental health services. 4,5 Medical effectiveness studies 6-8 with atypical antipsychotic agents reveal that, even with these newer medications, continuity of treatment can remain a significant problem. Naturalistic follow-up studies 6-8 find patients with psychotic illnesses changing medications at rates inconsistent with optimal care, with some receiving no medications for extended periods of time. 5, 8 To investigate, describe, and begin to quantify the magnitude of this problem, we studied patients discharged from state hospitals in Illinois while taking risperidone during the first year of the medication's commercial availability. By and large, this is a population of patients with severe mental illness and low socioeconomic status. Tracking medication use, we looked at the following:1. What proportion of patients continued to receive risperidone at outpatient follow-up?Objective: To investigate continuity of outpatient antipsychotic pharmacotherapy with risperidone in patients discharged from state psychiatric hospitals.Methods: Of 1,201 patients discharged from Illinois state psychiatric hospitals while taking risperidone during the first year of the medication's commercial availability, 627 public aid-eligible patients were trackable on the basis of public aid billing data. Data on risperidone continuation and other medication use for these patients were collected for the two-year period following each patient's discharge.Results: Forty-four percent of the patients discontinued risperidone within two weeks of hospital discharge, with one-half receiving no medications and most of the remainder switching to other antipsychotics. More than 75% of the patients discontinued risperidone within one year of hospital discharge, and fewer than 1% received continuous risperidone pharmacotherapy for the two-year follow-up period. Conclusions:Although the study methods do not permit us to draw conclusions regarding specific reasons for risperidone discontinuation in this patient sample, 66% of whom had a diagnosis of schizophrenia or schizoaffective disorder and 86% of whom had psychotic diagnoses, the rapid drop-off and discontinuity in medication management following hospital discharge is almost certainly inconsistent with optimum clinical care for this group of patients. Discontinuities in maintenance pharmacotherapy may compromise medical effectiveness, even for newer antipsychotic medications such as risperidone.

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Loveland

Boyle²,

Godley

et al. 2003

Administration and Policy in Mental Health

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Continuity of pharmacotherapy was examined between a state psychiatric hospital and an urban community mental health center. Anecdotal reports from administrators as well as limited empirical research suggested that there would be breaks in the continuity of pharmacotherapy across the two agencies and that the high cost of newer medications would contribute to poor continuity. Clinical chart reviews of 242 discharges over a 5-year period revealed that less than 11% of atypical prescriptions and less than 20% of all psychotropic prescriptions were altered beyond dosage level changes after discharge from a state hospital. Analysis of reasons given (reported) for altering the medication regimen revealed a consistent pattern of changes based on clinical evidence or consumer choice.

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Real-World Pharmacotherapy with Novel Antipsychotics

Cited by 4 publications

References 0 publications

"Real World" Atypical Antipsychotic Prescribing Practices in Public Child and Adolescent Inpatient Settings

"Real World" Atypical Antipsychotic Prescribing Practices in Public Child and Adolescent Inpatient Settings

Discontinuity of Outpatient Antipsychotic Pharmacotherapy: Risperidone Maintenance after Hospitalization

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