Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111969

David Garver, MD¹, Arthur Lazarus, MD², Kitty Rajagopalan, PhD², Laura M. Katz, MPH³, Lee S. Stern, MS³, Margarita Dolgitser³, and John J. Doyle, DrPH³. (1) University of Louisville, 3 East Mill Place, Louisville, KY 40222, (2) AstraZeneca, 1800 Concord Pike, B3B-425, PO Box 15437, Wilmington, DE 19850, (302) 885-4542, arthur.lazarus@astrazeneca.com, (3) Analytica International, 450 Park Avenue South, 12th Floor, New York, NY 10016

Objective: Examine outcome differences due to race and polypharmacy treatment in patients with bipolar disorder (BPD). Methods: Using a retrospective cohort design, patients from a Midwest vertically integrated healthcare system were identified based on BPD diagnosis code and prescription for anticonvulsant, mood stabilizer, typical, or atypical antipsychotic from 1998-2004, with two years of enrollment required. Number of BPD medications, polypharmacy (≥2 psychotropic medications during follow-up), resource utilization, and outcomes were examined overall and by race. Logistic models assessed the relationship between outcomes [emergency department (ED) visits and hospitalizations] and polypharmacy, adjusting for covariates. Results: Of 1,113 patients meeting inclusion criteria, 29.3% were black and 70.7% non-black. More than one third (36.6%) of patients were on polypharmacy during follow-up. 41.1% of black patients received ≥2 psychotropic medications versus 34.7% of non-black patients (p=0.043). Overall black patients received significantly fewer psychotropic scripts than non-black patients (8.35 and 10.31, respectively; p<0.0001). Adjusting for covariates, patients with polypharmacy were significantly more likely to be hospitalized or visit the ED than patients without polypharmacy (OR=1.37, 95%CI: 1.06-1.77; p=0.017). Race was also a significant predictor; black patients were significantly more likely to be hospitalized or visit the ED than non-black patients (OR=1.55, 95%CI: 1.18-2.04; p=0.002). Conclusion: High prevalence of polypharmacy was found in BPD patients overall, with black patients more likely on polypharmacy than non-black patients. Those with polypharmacy were more likely to visit the ED or be hospitalized; black patients were more likely to have an ED visit or hospitalization than non-black patients.

Learning Objectives:

• Describe the prevalence of polypharmacy in patients with bipolar disorder
• Understand how polypharmacy is predictive of resource utilization and patient outcomes
• Describe the association between race and resource utilization

Keywords: Mental Health Care, Underserved Populations

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commertial supporters WITH THE EXCEPTION OF Employed by AstraZeneca.

Recorded presentation