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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Patricia Russo, Director, Outcomes Research and Econometrics, The MEDSTAT Group, 4301 Connecticut Avenue NW, Suite 330, Washington, DC 20008, 202 719-7826, pat.russo@medstat.com, Liisa Palmer, PhD, Outcomes Research and Econometrics, The MEDSTAT Group, 4301 Connecticut Avenue NW, Suite 330, Washington, DC 20008, and Joseph Vasey, PhD, Health Policy and Administration, The Pennsylvania State University, 16 Henderson Building, University Park, PA 18102.
Objective: To examine the impact of clinical syndrome and type of antipsychotic medication on outpatient and inpatient utilization for persons enrolled in the U.S. Schizophrenia Care and Assessment Program (SCAP), a prospective research initiative.
Methods: Baseline data were used to predict 1-year outpatient and inpatient utilization (n=806). Psychotherapy (individual and group), clinic visits (medical services for specimen collection), rehabilitation treatment, day treatment and hospitalizations were examined. Presence of antipsychotic agents was coded for first generation (reference group), second generation, use of both first and second-generation agents, and no antipsychotic medication use. Logistic and negative binomial regressions using predicted values obtained through joint determination (SURE) of clinical/functional status were conducted with demographic variables used as controls.
Results: Medication assignment played a significant and mixed role in the use of services. Persons with a combination of first and second-generation antipsychotics exhibited a higher likelihood (p<0.001) and a greater number of psychotherapy visits (p<0.001). They also experienced a higher likelihood of day treatment (p=0.002) and shorter hospital length of stay (p=0.03). Persons prescribed only second-generation antipsychotics had a higher likelihood (p=0.001) and greater number of psychotherapy visits (p=0.03). The likelihood and number of clinic visits were lower (p=0.05 and p<0.001 respectively) and the probability of rehabilitation visits was higher (p=0.04) for those receiving only second-generation antipsychotic medications. Depression (MADRS) and functionality (GAF) exhibited an inverse relationship to number of clinic visits. Higher functioning also led to a lower probability (p=0.001) of experiencing day treatment. Higher QLS scores were associated with a higher likelihood of day treatment (p<0.001) and fewer total inpatient days of care (0.05).
Conclusions: This analysis indicates that type of antipsychotic medication prescribed impacts the probability and the number of outpatient services and total days of inpatient care; the impact however is mixed and warrants further investigation.
Clinical and functional status impact service utilization and the results suggest a ‘bimodal’ utilization effect. Individuals with higher levels of functioning may require fewer services to maintain community functioning, while individuals with lower levels of functioning may not be well enough to participate in certain outpatient services.
These findings suggest that medication regimen and functional status are significant determinants of inpatient and outpatient psychiatric service utilization and evaluation of these factors may lead to better clinical management and policy decision-making for persons with schizophrenia.
Learning Objectives:
Keywords: Mental Health, Health Care Utilization
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.