The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements.

In light of the large number of studies published since the 2004 update of Schizophrenia Patient Outcomes Research Team psychopharmacological treatment recommendations, we conducted an extensive literature review to determine whether the current psychopharmacological treatment recommendations required revision and whether there was sufficient evidence to warrant new treatment recommendations for prespecified outcomes of interest. We reviewed over 400 articles, which resulted in 16 treatment recommendations: the revision of 11 previous treatment recommendations and 5 new treatment recommendations. Three previous treatment recommendations were eliminated. There were 13 interventions and/or outcomes for which there was insufficient evidence for a treatment recommendation, and a statement was written to summarize the current level of evidence and identify important gaps in our knowledge that need to be addressed. In general, there was considerable consensus among the Psychopharmacology Evidence Review Group and the expert consultants. Two major areas of contention concerned whether there was sufficient evidence to recommend specific dosage ranges for the acute and maintenance treatment of first-episode and multi-episode schizophrenia and to endorse the practice of switching antipsychotics for the treatment of antipsychotic-related weight gain. Finally, there continue to be major gaps in our knowledge, including limited information on (1) the use of adjunctive pharmacological agents for the treatment of persistent positive symptoms or other symptom domains of psychopathology, including anxiety, cognitive impairments, depressive symptoms, and persistent negative symptoms and (2) the treatment of co-occurring substance or medical disorders that occur frequently in individuals with schizophrenia.

Utilizing new prescription drugs: disparities among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites.

OBJECTIVE: To examine racial and ethnic disparities in new prescription drug use. DATA SOURCES/STUDY SETTING: Secondary data analyses of the Medical Expenditure Panel Survey (1996-2001), a national survey representative of U.S. noninstitutionalized civilian population. Drug approval dates were from the GenRx database of Mosby. STUDY DESIGN: A negative binomial model was used to compare annual number of times when new drugs were obtained across racial and ethnic groups. Covariates in the model were demographic, economic characteristics, and health status. Drugs were considered new if approved within the past 5 years. We compared non-Hispanic whites with non-Hispanic blacks, and non-Hispanic whites with Hispanic whites, respectively, to examine racial and ethnic disparities separately. PRINCIPAL FINDINGS: Descriptive analyses found smaller racial disparities than ethnic disparities: the average annual number of times when new drugs were obtained was higher among non-Hispanic whites than non-Hispanic blacks (1.71 versus 1.36; p<.01) and Hispanic whites (1.71 versus 1.11; p<.01). Multivariate analyses found smaller ethnic than racial disparities: the number was 22-33 percent lower among non-Hispanic blacks than non-Hispanic whites (significant), and 5-16 percent lower among Hispanic whites than non-Hispanic whites (not always significant), respectively. While the absolute racial disparities decreased over the early years of the life cycles of the products, the reduction in disparities over time was not significant. CONCLUSIONS: There are racial disparities in the use of new medications, which persist during the first 5 years of marketing. Socioeconomic and health characteristics account for a larger share of ethnic disparities than racial disparities.

Disparities in access to essential new prescription drugs between non-Hispanic whites, non-Hispanic blacks, and Hispanic whites.

Prior studies do not address racial and ethnic disparities in essential new drug use and whether disparities decrease through time. Using the Medical Expenditure Panel Survey (1996-2001), racial and ethnic disparities were examined separately by comparing non-Hispanic whites to non-Hispanic blacks and Hispanic whites, respectively. New drugs were defined as approved within the past 5 years, and an expert panel identified essential drugs. Negative binomial models adjusted for socioeconomic and health characteristics. The mean annual number of times essential new drugs were obtained among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites were 1.02, 0.94, and 0.70, respectively. After adjusting for confounders, ethnic disparities generally were not significant, but racial disparities became significant. This study did not identify declining disparities during early years of drugs' life cycles. Disparities exist in new, essential drug acquisition between non-Hispanic whites and non-Hispanic blacks. Socioeconomic and health characteristics explain many of the observed disparities.