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2015 HSR&D/QUERI National Conference Abstract

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3139 — Changes in antipsychotic prescribing among patients with serious mental illness in the Veterans Health Administration medical system, FY2000-FY2013

Bowersox NW, SMITREC; Visnic S, SMITREC; Grindle C, SMITREC; Armstrong B, SMITREC; McCarthy JF, SMITREC;

Objectives:
Although antipsychotic medications (APs) are widely used in the care of patients with serious mental illness (SMI) in the Veterans Health Administration (VHA), there has been limited investigation into longitudinal trends in AP prescribing. Such information can demonstrate shifts in prescribing practices related to the use of APs with differential rates of metabolic side effects, use of clozapine, and tendency to prescribe multiple concurrent APs.

Methods:
Information was collected from the National Psychosis Registry, an administrative data source focusing on care of VHA patients with SMI. "Medication receipt" was defined as receipt of at least one prescription during the index year. Measures of the proportion of patients in different SMI subgroups (schizophrenia spectrum disorders, bipolar spectrum disorders, other psychotic disorders) who received at least one prescription in each index year were created for specific atypical APs and APs overall. Additional measures of the average number of AP medication fills were created. A measure of receipt of "concurrent AP treatment" was created in cases where patients had AP fills that overlapped for a period of 60 days or more.

Results:
During the index period, the proportion of SMI patients with at least one AP within their index year increased slightly (FY2000: 57.0%; FY2013: 61.7%), as did the average number of AP fills (FY2000: 7.5; FY2013: 8.1). Rates of receipt of olanzapine decreased markedly (FY2000: 39.3%; FY2013: 14.9%) and risperidone receipt decreased slightly (FY2000: 36.0%; FY2013: 29.1%), while there was a large increase in quetiapine (FY2000: 7.7%; FY2013: 32.0%), aripiprazole use (FY2003: 1.2%; FY2013: 20.5%), and ziprasidone use (FY2002: 3.5%; FY2013: 6.1%). During the index period, use of clozapine remained stable (FY2000: 1.9%; FY2013: 20.5%) as did rates of concurrent AP treatment (FY2000: 9.6%; FY2013: 10.0%).

Implications:
While VHA AP prescribing practices seem to be trending toward the use of medications with less severe metabolic side effects and increased side-effect tolerability, concurrent AP treatment remains relatively common and clozapine potentially underused in SMI pharmacotherapy.

Impacts:
Information on longitudinal prescribing trends can be useful to better understand care practices as well as potentially inform policy on AP care guidelines and care monitoring.