RCMI Pilot Project
January 1, 2020 – December 31, 2020
PI: Thomas Maestri, PharmD, BCPP
Title: A Description of Antipsychotic Prescribing Patterns Based on Race in an Expanded Population
Background: Rates of mental illnesses in African Americans are similar with those of the general population, however, disparities exist in regard to mental health care services. Compared with non‐ Hispanic whites, African Americans with any mental illness have lower rates of any mental health service use including prescriptions medications and outpatient services, but higher use of inpatient services. African Americans are more frequently diagnosed with schizophrenia and less frequently diagnosed with mood disorders due in part to expressions of symptoms of emotional distress. It is possible that African Americans are being exposed to higher doses and potentially inappropriate antipsychotic medications on the inpatient setting. This study will expand upon previous work performed at a single institution to address the issues of low sample size and generalizability.
Objectives: (1) Describe the prescribing patterns of antipsychotic medications to patients from different racial and ethnical backgrounds, with a focus on dosing. (2) Explore appropriateness to therapy, as defined by adherence to FDA‐labeling and avoidance of inappropriate polypharmacy, in order to target potential mental health disparities related to antipsychotic medication exposure. Methods: This is a multi‐centered, retrospective, chart review of 1000 patients admitted into inpatient behavioral health units and discharged having any psychotic diagnosis indicating a prescription for an antipsychotic or a long‐acting formulation of an antipsychotic given prior to discharge. Differences in antipsychotic drug, dose, types, number, and duration will be characterized, with dosing standardized to “Chlorpromazine Equivalents”. Descriptive in nature, this study will compare antipsychotics prescribed at discharge in correlation to the psychiatric discharge diagnosis, race/ethnicity, mental health condition, healthcare insurance coverage, and other socioeconomic and environmental factors. All data will be analyzed using the R statistical language, with Holm and Bonferroni multiple comparison corrections. Chlorpromazine Equivalent Doses will be modeled using liner regression.
Outcomes: We will report on individual characteristics, such as age, past antipsychotic trials, severity of illness, and others that could potentially influence antipsychotic dosing and appropriateness in the inpatient setting. Characteristics will be further classified by race using descriptive statistics. This study will be used to develop a more targeted approach to addressing health disparities in antipsychotic prescribing.
Project Narrative:
Non‐Hispanic black and Hispanic patients have been reported to receive a diagnosis of schizophrenia upwards of 3 times higher than non‐Hispanic whites, while receiving a diagnosis of depression less frequently despite race/ethnicity theoretically playing no role in disease development. Despite the documented disparities in the diagnosis of mood and thought disorders, it is unclear whether minority populations are getting exposed to disproportionate number and type of medications to treat these illnesses. This study aims to identify prescribing patterns that expose minority populations to excess antipsychotic medications so that future research can focus efforts on education of physicians.