Wednesday, 2 April 2003

This presentation is part of : Poster Session 1

Factors Influencing the Prescribing of Atypical Antipsychotic Pharmacotherapy: Does Age Matter?

David A. Sclar1, Tracy L. Skaer1, Linda M. Robison1, Michael W. Dickson2, C. Lindsay DeVane3, and John S. Markowitz4. (1) College of Pharmacy, Washington State University, Pullman, WA, USA, (2) Department of Pharmaceutical and Health Outcome Sciences, University of South Carolina, Columbia, SC, USA, (3) Institute of Psychiatry, Medical University of South Carolina, Charleston, SC, USA, (4) College of Pharmacy, Medical University of South Carolina, Charleston, USA

Objective: Recent pharmacotherapeutic advances in the treatment of psychoses have included the development of atypical antipsychotics, thereby providing an alternative to conventional pharmacotherapy. This study was designed to identify factors influencing the prescribing of atypical antipsychotic pharmacotherapy compared to conventional antipsychotic pharmacotherapy among (1) patients 18 years old, and (2) among patients 65+ years old.

Design: Retrospective cohort study.

Materials and Methods: Adjudicated patient-level, paid-claims data from South Carolina's Medicaid program for the time period 1996, through 1999, were utilized for this analysis. The study population was a statewide cohort of 16,845 ambulatory Medicaid beneficiaries initiating pharmacotherapy with either a conventional or atypical antipsychotic. Logistic regression-derived odds ratios (OR) and 95% confidence intervals (CI) were used to elucidate factors predictive of receipt of atypical antipsychotic pharmacotherapy. Model variables included age (18-64 years compared to 65+ years); race (white compared to nonwhite); sex; and psychiatric service intensity (number of psychiatric service claims within 30 days of initiating antipsychotic pharmacotherapy).

Results: 24% of the study population was 65+ years old, 65% were female, and 38% were white. Younger patients (<65 years old) were 80% more likely to initiate antipsychotic pharmacotherapy with an atypical medication than were patients 65+ years old (OR = 1.8, 95% CI = 1.6 - 1.9). Among patients 65+ years old, female gender (OR = 1.2, 95% CI = 1.1 - 1.4), white race (OR = 1.6, 95% CI = 1.4 - 1.9), and higher psychiatric service intensity (OR = 2.1, 95% CI = 1.8 - 2.5) were significant predictors of initiating antipsychotic pharmacotherapy with an atypical medication.

Conclusion: Initiating pharmacotherapy with an atypical antipsychotic is influenced by a patient's age, gender, race, and intensity of psychiatric services. Further research is needed to discern the reasons for these observed differences and to advance clinically rational and equitable access to pharmacotherapeutic innovation.

Back to Poster Session 1
Back to Oral and Poster Sessions
Back to The IPA European Regional Meeting (1-4 April 2003) of IPA