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*310. Antipsychotic Prescribing Practices

SM Essock, VISN 3 MIRECC & Mount Sinai School of Medicine; EW Weissman, VISN 3 MIRECC & Mount Sinai School of Medicine; G Sullivan, VISN 16 MIRECC & University of Arkansas for Medical Sciences; SR Marder, VISN 23 & University of California, Los Angeles; RR Owen, Director, HSR&D Center for Mental Health Care and Outcomes Research & University of Arkansas for Medical Sciences

Objectives: Antipsychotic medications remain the primary intervention for most veterans with schizophrenia, hence understanding how best to use these medications remains a central challenge in their treatment. Evidence-based medication algorithms hold great promise, but operationalizing and translating them into routine practice settings presents obstacles in multiple domains. The high pill cost of the newer antipsychotic medications highlights issues of cost effectiveness and the fiscal incentives and disincentives for medication choice. This workshop will focus on the following topics with the following objectives:

1) Describing what we know about current prescribing practices: Providing prescription level and patient-level prescribing data on the frequency of use of the older and newer antipsychotic medications; illustrating how their use appears to be driven by factors other than their relative effectiveness; describing variations in practice style across facilities; examining what we are spending on antipsychotic medications; identifying apparent barriers to access to more effective antipsychotic medications; identifying prescribing incentives and disincentives created by institutional policies and procedures.

2) Describing what prescribers say about their prescribing choices and difficulties and their attitude about medication algorithms: a presentation of results of focus groups of line staff making prescribing decisions.

3) Examining the dilemma of polypharmacy (concurrent use of two or more antipsychotics): This practice is at the bottom of most treatmentalgorithms yet at the top of many practitioners' favored approaches. Is this bad? How can we make statements about when polypharmacy should raise a possible quality flag?

4) Describing translation efforts to impact prescribing practices and improve outcomes for veterans with schizophrenia.

Activities: Each of the presenters will provide data to meet one or more of the objectives stated above. The talks will emphasize the tensions which arise when proposing to implement evidence-based guidelines when the evidence base does not extend to some commonly encountered treatment situations and/or conflict with commonly encountered current practice patterns. The presentations will be kept brief to allow for a discussion of the best ways to monitor and intervene to improve prescribing practices in the face of the real-world complexities described.

Audience: The target audience consists of individuals charged with monitoring and improving the quality of care for veterans with psychiatric disorders, including individuals who are charged with monitoring the cost effectiveness of such care, mental health product line managers, and others interested in the complexities of striving for evidence based practice.

Audience Familiarity: None.