Variations in Prescribing Practices for Novel Antipsychotic Medications Among Veterans Affairs Hospitals

Owen, Richard R.; Feng, Weiwei; Thrush, Carol R.; Hudson, Teresa J.; Austen, Mark A.

doi:10.1176/appi.ps.52.11.1523

Cited by 44 publications

(22 citation statements)

References 7 publications

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“…There are occasional studies that have found no differences in doses (Kreyenbuhl et al, 2003) and types of antipsychotic prescribed (Pinninti et al, 2003;Woods et al, 2003), but most other studies have found differences in doses (Segal et al, 1996;Walkup et al, 2000;Diaz and de Leon, 2002), types of antipsychotics prescribed (Baillargeon and Contreras, 2001;Owen et al, 2001;Covell et al, 2002;Copeland et al, 2003;Daumit et al, 2003;Kreyenbuhl et al, 2003;Opolka et al, 2003) and rates of polypharmacy (Taylor, 2004). All of these studies indicated poorer prescribing quality in black patients.…”

Section: Previous Studiesmentioning

confidence: 99%

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Antipsychotic prescribing quality and ethnicity — a study of hospitalized patients in south east London

Connolly

Rogers

Taylor³

2007

J Psychopharmacol

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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.

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Section: Previous Studiesmentioning

confidence: 99%

“…All studies examined collected information on age, sex and race but the numbers of other factors studied ranged from only one (Baillargeon and Contreras, 2001;Owen et al, 2001) to up to ten (Kreyenbuhl et al, 2003). Most studies made no attempt to account for even these few confounders.…”

Section: Previous Studiesmentioning

confidence: 99%

Antipsychotic prescribing quality and ethnicity — a study of hospitalized patients in south east London

Connolly

Rogers

Taylor³

2007

J Psychopharmacol

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“…As described elsewhere, 5,11 6 VA Medical Centers (VAMCs), 2 from each of 3 Veterans Integrated Service Networks (VISNs), were selected to participate in the Schizophrenia Guidelines Project. Within each participating VISN, 1 VAMC was randomly selected to receive an enhanced intervention.…”

Section: Overviewmentioning

confidence: 99%

The Effectiveness of Guideline Implementation Strategies on Improving Antipsychotic Medication Management for Schizophrenia

Owen¹,

Hudson²,

Thrush³

et al. 2008

Medical Care

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The enhanced guideline implementation strategy increased addition of SGAs to FGA therapy, but did not significantly increase guideline-recommended switching from FGA to SGA monotherapy. Antipsychotic dosing was not significantly altered. The study illustrates the challenges of changing clinical behavior. Strategies to improve medication management for schizophrenia are needed, and must incorporate recommendations likely to emerge from recent research suggesting comparable effectiveness of SGAs and FGAs.

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“…Regional variation in health services delivery has been well described [15][16][17][18][19][20][21]. In contrast, little is known about regional patterns of prescription drug utilization beyond focused studies of prescribing patterns for antibiotics [1], chemotherapy [22], cholinesterase therapy [23], psychiatric medications [24], and statin cholesterol lowering agents [25].…”

Section: Introductionmentioning

confidence: 99%

Visualizing nationwide variation in Medicare Part D prescribing patterns

Rosenberg

Fucile

White

et al. 2017

Preprint

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Objective To characterize the regional and national variation in prescribing patterns in the Medicare Part D program using machine learning and dimensional reduction visualization methods. Methods Using publicly available Medicare Part D claims data, we identified regional and national provider prescribing profile variation with unsupervised clustering and t-distributed stochastic neighbor embedding (t-SNE) dimensional reduction techniques. Additionally, we examined differences between regionally representative prescribing patterns for major metropolitan areas. Results Distributions of prescribing volume and medication diversity were highly skewed among over 800,000 Medicare Part D providers, and medical specialties had characteristic prescribing patterns. Although the number of Medicare providers in each state was highly correlated with the number of Medicare Part D enrollees, some states were enriched for providers with >10,000 prescription claims annually. Hierarchical clustering and t-SNE dimension-reduction visualization of drug-or drug-class prescribing patterns revealed that providers cluster strongly based on specialty and sub-specialty, with large regional variations in prescribing patterns. Major metropolitan areas had distinct prescribing patterns that tended to group by major geographical divisions. Conclusions There is substantial prescribing variation among providers in Medicare Part D both between and within specialties. Large regional variations in prescribing patterns, particularly among major metropolitan areas, were also seen. Unsupervised clustering and t-SNE dimension-reduction are an effective means to examine variation in provider prescribing patterns, including substantial regional and medical specialty variation.

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Variations in Prescribing Practices for Novel Antipsychotic Medications Among Veterans Affairs Hospitals

Cited by 44 publications

References 7 publications

Antipsychotic prescribing quality and ethnicity — a study of hospitalized patients in south east London

Antipsychotic prescribing quality and ethnicity — a study of hospitalized patients in south east London

The Effectiveness of Guideline Implementation Strategies on Improving Antipsychotic Medication Management for Schizophrenia

Visualizing nationwide variation in Medicare Part D prescribing patterns

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