Factors Affecting Prescribing Behaviors of Benzodiazepines and Antipsychotics to Patients with Mental Health Diagnoses in an Academic Medical Center Emergency Department

Abstract

Objectives: To determine whether disparities exist among mental health patients admitted to the emergency department in regards to the prescribing patterns of injectable benzodiazepines and antipsychotics. Methods: A retrospective chart review was performed to evaluate patients with mental health diagnoses who received an injectable antipsychotic or benzodiazepine while in the emergency department of an academic medical center. A report was generated of all injectable antipsychotics and benzodiazepines removed from the emergency department Pyxis machines from November 1, 2013 to January 31, 2014. Data from the patient medical record included the patient’s age, height, weight, gender, race/ethnicity, insurance information, mental health diagnosis, evidence of substance abuse, how they arrived in the emergency department, their length of stay in the emergency department, any signs of aggressive behavior (adapted from the Overt Aggression Scale), information about each injectable antipsychotic or benzodiazepine that was administered was recorded including the name of the medication, dose, route of administration. If the patient received multiple doses of the same medication during their stay, the total dose and the total time receiving the medication was also recorded. The prescriber’s gender and whether they were a resident or an attending physician was also recorded for each medication administered. Results: A total of 98 patient charts were reviewed and analyzed. Mental health diagnoses were broken down into categories of psychiatric disorders (39.8%), bipolar disorders (74.5%), mood disorders (40.8%), and personality disorders 54.1%). Of the 98 patients reviewed, 68% had a documented substance abuse, with 62% having a positive urinalysis for alcohol, illicit drugs, or opiates. The majority of the patients were white (64.3%). The next largest racial/ethnic categories were Hispanics (12.2%), Native Americans (8.2%), and African Americans (6.1%). There were 54 males and 44 females. Benzodiazepines comprised 74% of the medications administered with lorazepam being the most frequently administered medication overall at 63.4%. Haloperidol was the second most frequently administered medication at 22%. Initial Chi Square analysis did not yield any significant results with regards to race and prescribing patterns, gender and prescribing patterns, or insurance and prescribing patterns. Conclusions: Patients with mental health diagnoses suffer from disparities within health care, and when these patients fall under other demographic groups such as racial/ethnic minorities and low socioeconomic status, the disparate treatment they receive could be even greater. Several limitations to this study including a small sample size and lack of geographical diversity resulted in a lack of statistically significant results, and our findings may not be generalizable to other patient populations.