Variation in Psychotropic Medication Prescription for Adults With Schizophrenia in the United States
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Data Source
Cohort Selection
Analysis of Prescription Patterns
Demographic, Clinical, and Service Use Covariates
Analysis Strategy
Results
Sample Characteristics
Characteristic | N | % |
---|---|---|
Age (M±SD years) | 43.2±12.6 | |
Women | 174,272 | 48.7 |
Race-ethnicity | ||
White, non-Hispanic | 141,261 | 39.5 |
Black, non-Hispanic | 125,256 | 35.0 |
Hispanic or Latino | 41,262 | 11.5 |
Otherb | 50,135 | 14.0 |
Schizophrenia subtypes | ||
Schizoaffective | 118,930 | 33.2 |
Schizophreniform | 2,007 | .6 |
Psychiatric comorbid conditions (2011) | ||
Substance use disorder | 54,895 | 15.3 |
Depression | 119,738 | 33.5 |
Anxiety | 55,468 | 15.5 |
Deliberate self-harm | 2,796 | .8 |
General medical comorbid conditions (2011) | ||
Diabetes | 75,833 | 21.2 |
Serious cardiovascular disease | 126,636 | 35.4 |
Hyperlipidemia | 86,153 | 24.1 |
Financing arrangement | ||
Fee for service | 246,640 | 68.9 |
Managed care | 109,017 | 30.5 |
Otherc | 2,257 | .6 |
Outpatient visits for schizophrenia | ||
0–9 | 217,252 | 60.7 |
10–29 | 64,774 | 18.1 |
30–49 | 24,852 | 6.9 |
≥50 | 51,036 | 14.3 |
Mental health emergency department visit (2011) | 92,552 | 25.9 |
Inpatient admission for schizophrenia (N visits) | ||
0 | 288,876 | 80.7 |
1 | 34,453 | 9.6 |
2 | 15,819 | 4.4 |
3 | 6,297 | 1.8 |
≥4 | 12,469 | 3.5 |
N of psychotropic medication types taken per year | ||
1 | 107,538 | 30.1 |
2 | 137,178 | 38.3 |
3 | 87,440 | 24.4 |
4 | 24,420 | 6.8 |
5 | 1,338 | .4 |
Psychotropic medication typed | ||
Any antipsychotic | 306,103 | 85.5 |
LAI antipsychotic | 51,427 | 14.4 |
Clozapine | 15,679 | 4.4 |
Antidepressant | 207,531 | 58.0 |
Mood stabilizer | 99,758 | 27.9 |
Benzodiazepine | 97,468 | 27.2 |
Demographic, Clinical, and Service Use Predictors of Psychotropic Medication Prescriptions
Antipsychotic medications | LAI | Clozapine | Antidepressants | Benzodiazepines | Mood stabilizers | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Demographic characteristic | AOR | 99% CIb | AOR | 99% CIb | AOR | 99% CIb | AOR | 99% CIb | AOR | 99% CIb | AOR | 99% CIb |
Age (continuous) | .99* | .99–.99 | .99* | .99–.99 | .98* | .98–.98 | 1.01* | 1.00–1.01 | 1.01* | 1.01–1.01 | .98* | .98–.98 |
Women (reference: men) | .81* | .79–.83 | .78* | .76–.80 | .82* | .78–.86 | 1.47* | 1.44–1.50 | 1.38* | 1.35–1.41 | 1.00 | .98–1.02 |
Race-ethnicity (reference: White, non-Hispanic) | ||||||||||||
Black, non-Hispanic | 1.16* | 1.12–1.19 | 1.39* | 1.35–1.44 | .40* | .38–.42 | .71* | .69–.73 | .51* | .49–.52 | .69* | .67–.71 |
Asian | 1.26* | 1.13–1.41 | 1.10 | .99–1.23 | .83* | .72–.96 | .60* | .56–.65 | .63* | .58–.69 | .72* | .66–.78 |
Hispanic | 1.10* | 1.03–1.17 | 1.26* | 1.19–1.34 | .63* | .57–.69 | .95* | .92–.99 | 1.00 | .95–1.04 | .74* | .71–.78 |
Native Hawaiian or other Pacific Islander | 1.55* | 1.30–1.84 | 1.26* | 1.11–1.44 | .80* | .66–.97 | .69* | .63–.75 | .63* | .57–.70 | .72* | .65–.80 |
Schizophrenia subtype (reference: schizophrenia) | ||||||||||||
Schizoaffective | 1.00 | .98–1.03 | .77* | .75–.80 | .91* | .87–.96 | 1.35* | 1.32–1.38 | 1.14* | 1.11–1.16 | 1.60* | 1.57–1.64 |
Schizophreniform | 1.15 | .96–1.37 | .91 | .76–1.09 | .77 | .56–1.07 | .93 | .82–1.05 | 1.04 | .90–1.20 | 1.00 | .87–1.15 |
Psychiatric comorbid condition | ||||||||||||
Substance use disorder (reference: none) | .82* | .79–.85 | .83* | .80–.87 | .45* | .41–.50 | 1.41* | 1.37–1.45 | 1.09* | 1.06–1.13 | .88* | .86–.91 |
Depression (reference: none) | .72* | .70–.74 | .65* | .63–.67 | .56* | .53–.60 | 2.06* | 2.01–2.10 | 1.17* | 1.14–1.20 | .92* | .90–.94 |
Anxiety (reference: none) | .69* | .67–.72 | .66* | .63–.69 | .65* | .60–.70 | 1.41* | 1.37–1.45 | 2.33* | 2.27–2.40 | .88* | .86–.91 |
Deliberate self-harm (reference: none) | 1.03 | .89–1.19 | 1.02 | .88–1.19 | .92 | .66–1.29 | 1.46* | 1.29–1.66 | 1.07 | .95–1.19 | 1.05 | .94–1.17 |
Comorbid general medical condition | ||||||||||||
Diabetes (reference: none) | 1.08* | 1.04–1.12 | 1.06* | 1.03–1.10 | 1.48* | 1.40–1.57 | 1.10* | 1.07–1.13 | 1.08* | 1.05–1.11 | 1.12* | 1.09–1.15 |
Serious cardiovascular disease (reference: none) | .86* | .83–.89 | .84* | .81–.86 | .98* | .93–1.03 | 1.19* | 1.16–1.21 | 1.30* | 1.27–1.33 | 1.06* | 1.04–1.09 |
Hyperlipidemia (reference: none) | 1.13* | 1.09–1.17 | .91* | .88–.94 | 1.44* | 1.37–1.52 | 1.07* | 1.05–1.10 | 1.04* | 1.01–1.07 | 1.06* | 1.03–1.08 |
Financing arrangement (reference: FFS)c | ||||||||||||
Managed care | .46* | .44–.48 | .81* | .77–.84 | .77* | .72–.83 | 1.24* | 1.20–1.27 | .99 | .96–1.02 | .89* | .86–.92 |
Other | .23* | .20–.26 | .61* | .50–.74 | .16* | .08–.31 | .24* | .21–.27 | .19* | .14–.24 | .20* | .16–.25 |
Psychiatric service use | ||||||||||||
Outpatient schizophrenia visits (reference: 0–9) | ||||||||||||
10–29 | 1.94* | 1.86–2.02 | 2.65* | 2.55–2.74 | 2.36* | 2.22–2.51 | .78* | .76–.80 | .86* | .84–.89 | .89* | .86–.92 |
30–49 | 2.27 | 2.13–2.42 | 4.25* | 4.06–4.45 | 3.10* | 2.86–3.36 | .75* | .72–.78 | .83* | .79–.87 | .97 | .93–1.01 |
≥50 | 2.75 | 2.61–2.88 | 5.32* | 5.13–5.52 | 4.88* | 4.59–5.18 | .73* | .71–.75 | .82* | .79–.85 | 1.15* | 1.12–1.19 |
Mental health ED visit (reference: none) | 1.18* | 1.14–1.22 | 1.44* | 1.39–1.49 | .77* | .72–.82 | .95* | .92–.97 | 1.12* | 1.09–1.15 | 1.36* | 1.32–1.40 |
Inpatient schizophrenia admission visit (reference: 0) | ||||||||||||
1 | 1.13* | 1.08–1.19 | 1.36* | 1.30–1.43 | .92 | .84–1.00 | .91* | .88–.95 | 1.04* | 1.00–1.08 | 1.30* | 1.26–1.35 |
2 | 1.32* | 1.23–1.42 | 1.58* | 1.48–1.69 | 1.01 | .90–1.15 | .83* | .79–.87 | 1.04 | .99–1.10 | 1.45* | 1.38–1.52 |
3 | 1.53* | 1.36–1.71 | 1.80* | 1.64–1.98 | 1.12 | .93–1.34 | .83* | .77–.90 | 1.01 | .93–1.09 | 1.71* | 1.59–1.84 |
≥4 | 1.51* | 1.39–1.64 | 1.80* | 1.67–1.94 | 1.22* | 1.06–1.41 | .90* | .85–.96 | 1.08* | 1.01–1.15 | 1.75* | 1.65–1.85 |
State Variation in the Prescription of Psychotropic Medications
Post Hoc Analyses
Discussion
Conclusions
Supplementary Material
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