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Published Online: 1 August 2011

Outcome Assessment of an Antipsychotic Drug Algorithm: Effects of the Mississippi State Hospital Algorithm Project

Abstract

Objective:

This study evaluated a state psychiatric hospital's algorithm for prescribing antipsychotic drugs for inpatients with schizophrenia to determine whether its emphasis on cost efficiency is compatible with quality of care.

Methods:

Outcomes were compared for patients who received medication that was algorithm adherent or nonadherent. Risperidone and ziprasidone were first-step oral antipsychotics. Documentation of clinical rationale was acceptable for nonpreferred drug use. Outcomes of interest were length of hospitalization and “much improved” or “very much improved” status on the Clinical Global Impression severity scale (CGI-S).

Results:

Of 401 patients, 70% were male. The CGI-S modal rating of severity was “markedly ill.” Duration of illness was longer for patients given algorithm-nonadherent (17.6±9.7 years) versus -adherent (14.9±11.6 years, p=.013) medication. No statistically significant between-group differences were observed for mean length of stay (51.4±35.5 days versus 43.8±27.4 days, adjusted difference p=.18) or median improvement time (adherent, 41 days; nonadherent, 42 days; CI=34–48 days for both group medians).

Conclusions:

Prescription algorithm adherence was not associated with significantly increased length of inpatient stay or delayed time to improvement. (Psychiatric Services 62:963–965, 2011)

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Table 1 Baseline characteristics of 401 inpatients administered antipsychotic medication that adhered or did not adhere to the hospital's prescribing algorithm

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Cover: The South Gorge, Appeldore, Isles of Shoals, by Childe Hassam. Oil on canvas, 22¼ × 18 inches. Collection of the Newark Museum, Newark, New Jersey. Photo credit: the Newark Museum/Art Resource, New York.
Psychiatric Services
Pages: 963 - 965
PubMed: 21807839

History

Published online: 1 August 2011
Published in print: August 2011

Authors

Details

Brian L. Crabtree, Pharm.D. [email protected]
Dr. Crabtree is affiliated with the Department of Pharmacy Practice, University of Mississippi, 2500 N. State St., Jackson, MS 39216 (e-mail: [email protected]).
Dr. Dostrow and Ms. Evans are with Mississippi State Hospital, Whitfield, where Dr. Crabtree is also affiliated.
Victor G. Dostrow, M.D.
Dr. Dostrow and Ms. Evans are with Mississippi State Hospital, Whitfield, where Dr. Crabtree is also affiliated.
Cynthia J. Evans
Dr. Dostrow and Ms. Evans are with Mississippi State Hospital, Whitfield, where Dr. Crabtree is also affiliated.
Brian J. Cuffel, Ph.D.
Dr. Cuffel, Dr. Alvir, and Ms. Sanders are with Pfizer, Inc., New York City.
Jose Ma. J. Alvir, Dr.P.H.
Dr. Cuffel, Dr. Alvir, and Ms. Sanders are with Pfizer, Inc., New York City.
Kafi N. Sanders, M.P.H.
Dr. Cuffel, Dr. Alvir, and Ms. Sanders are with Pfizer, Inc., New York City.

Notes

This work was presented in part at the International Society of Pharmacoeconomics Outcomes Research 14th annual international meeting, Orlando, Florida, May 16–20, 2009.

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