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.
Subject(s)
Antipsychotic Agents/therapeutic use , Drug Utilization , Hospitals, Veterans , Practice Patterns, Physicians' , Schizophrenia/drug therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , United States , VeteransABSTRACT
OBJECTIVE: This report describes the development, application, and exploratory evaluation of a clinical performance measure based on recently published schizophrenia guidelines for antipsychotic dose. DESIGN, SETTING, PARTICIPANTS: The performance measure, which assesses adherence to antipsychotic dose recommendations for acute schizophrenia treatment, was calculated at hospital discharge for 116 patients with schizophrenia who had participated in a 6-month outcomes study. MAIN OUTCOME MEASURE: The Brief Psychiatric Rating Scale (BPRS) was used to assess symptom severity at 6-month followup. RESULTS: At discharge, almost one-half of the patients were prescribed doses outside the recommended range. For the entire sample, linear regression models showed that the performance measure variable was not significantly associated with followup symptom severity (BPRS total scores). However, a significant association was observed for patients prescribed oral antipsychotics only (n = 69). Patients prescribed recommended doses had lower adjusted mean BPRS totals than patients prescribed doses either greater than (P < 0.05) or less than (P < 0.05) recommended. CONCLUSIONS: Our findings suggest that the antipsychotic dose performance measure may be useful for monitoring quality. It assesses a modifiable aspect of care for which clinical improvement is needed, and such improvement is likely to improve patient outcomes. Future research is needed to confirm our findings and to develop and test interventions to improve the quality of care for schizophrenia that incorporate this clinical performance measure.
Subject(s)
Antipsychotic Agents/administration & dosage , Guideline Adherence/statistics & numerical data , Quality Indicators, Health Care , Schizophrenia/drug therapy , Adult , Female , Humans , Longitudinal Studies , Male , Outcome and Process Assessment, Health Care , Patient Discharge , Psychiatric Status Rating Scales , Severity of Illness Index , United StatesABSTRACT
Suicide rates for the elderly continue to be the highest for any age group. Although these rates are known to be significant, little study has been given to the ethnic variability associated with this phenomenon. This retrospective study was undertaken to explore this issue and involved a review of the coroner's reports for completed elder suicides (65 years of age or older) for Honolulu County from 1987 through 1992 inclusive. The results showed a mean age of 75 years, with the highest incidence of completion in the 80+ age group. The predominant method of suicide completion in this study group was found to be hanging, followed by jumping, firearms, and poisoning. There were significant gender and ethnic differences in the method of suicide completion. Almost half of the sample saw a healthcare provider within the 6 months before their death. Comparisons with other elder suicide studies are presented.
