Patterns and Predictors of Antipsychotic selection in adult patients with schizophrenia

Abstract

Purpose: Antipsychotics are recommended for the pharmacologic treatment of schizophrenia spectrum disorders. This study used United States (US) national survey data to examine antipsychotic prescribing patterns among adults diagnosed with schizophrenia in the US. Methods: A retrospective, cross-sectional study was conducted using 2005-2015 National Ambulatory Medical Care Survey (NAMCS) data. The final study sample consisted of visits by 27,158 adults (unweighted n = 1,486; age ≥ 18 years) diagnosed with schizophrenia in the US. Treatment options were defined as a first-generation antipsychotic (FGA), second-generation antipsychotic (SGA), or no antipsychotic. To identify predictors of antipsychotic treatment, multivariable logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors. Results: Various factors predicted antipsychotic class selection for patients in the NAMCS database. Patients ≥65 years of age were 0.48 times as likely to be prescribed an SGA than patients 18-64 years old (95% CI [0.257,0.895]). Multiple race/other, non-Hispanic patients were 3.31 times more likely to receive an SGA over FGA (95% CI [1.187, 9.234]) than Black, non-Hispanic patients. Patients in the South were 0.44 times as likely to be prescribed an SGA antipsychotic than patients in the Midwest (95% CI [0.271, 0.721]). Patients in non-metropolitan areas were 0.47 times as likely to receive an SGA over FGA compared to patients in metropolitan areas (95% CI [0.269, 0.835]). Conclusions: Several factors were associated with SGA vs. FGA use. This information highlights disparities in antipsychotic prescribing. Further studies are needed to determine the impact of antipsychotic prescribing patterns on patient outcomes.