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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Nancy L Sohler, PhD, MPH, Epidemiology, Montefiore Medical Center, Albert Einstein College of Medicine, Rutgers University, 200 Haven Avenue 2K, New York, NY 10033, 212 923 2060, nsohler@montefiore.org, James Walkup, PhD, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 30 College Ave, New Brunswick, NJ 08901, Donna D. McAlpine, PhD, University of Minnesota, Rutgers University, 30 College Avenue, New Brunswick, NJ 08901, Mark Olfson, MD, New York State Psychiatric Institute, Department of Psychiatry at Columbia University, Rutgers University, 30 College Avenue, New Brunswick, NJ 08901, and Carol A. Boyer, PhD, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 30 College Avenue, New Brunswick, NJ 08901-1293.
Objective: Most definitions of optimal treatment for patients with schizophrenia assign a central role to effective use of antipsychotic medication. Practice guidelines based on clinical trials have been developed to offer specific medication dose recommendations, but little evidence is available from naturalistic studies regarding the influence on a range of clinical, social, and occupational outcomes of dosages falling within the recommendations.
Methods: Low, appropriate, and high antipsychotic discharge medication dose ranges were defined using the Patient Outcomes Research Team project recommendations for the treatment of patients with schizophrenia. Data were collected from Medicaid eligible patients with schizophrenia admitted to four NYC hospitals. A total of 246 patients were assessed at discharge and three months later.
Results: At three months, patients who were prescribed high discharge doses of medication had worse symptoms according to the Brief Psychiatric Rating Scale (44.8) than those prescribed appropriate doses (39.1), p<0.01. Patients prescribed low discharge doses did not differ significantly from those prescribed appropriate doses on symptoms, but were more likely to be non-compliant over the follow-up period: 21% of the appropriate dose group versus 39% of the low dose group were non-compliant, p=0.02. There were no significant differences observed in any other outcome domain.
Conclusions: Effects of discharge antipsychotic medication dosage falling within the window defined as appropriate may be limited to a narrow range of outcome domains at 3 months post-discharge. Future research will be needed to understand the impact of appropriate medication dosing on the effectiveness of other types of supportive interventions.
Learning Objectives:
Keywords: Mental Illness, Treatment Outcomes
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.