Edell WS, Tunis SL, Greenwood KL, Lim PZ; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 18.
Clinical Development, Horizon's Mental Health Outcomes, 1500 Waters Ridge Drive, Lewisville, Texas 75057, USA.
RESEARCH OBJECTIVE: This study reports current medication prescribing patterns for the treatment of Bipolar Disorder in both adult and geriatric inpatients. STUDY DESIGN: Data was taken from the 1996-1998 CQI+ Outcomes Measurement System developed by Mental Health Outcomes (MHO). Medication prescribing patterns were recorded for adult (n=458) and geriatric (n=824) patients at time of admission and discharge. Discharge medication was assumed to be the medication most likely used while the individual was in the program. Patients were grouped as either taking anti-manic and/or anti-psychotic agents at discharge. Of the six major medication groups identified, three groups of "mono-therapy" were Lithium, Depakote, and Zyprexa. Three "dual-therapy" groups were examined separately: Depakote plus Zyprexa, Depakote plus Risperdal, and Depakote plus a conventional anti-psychotic agent. In addition, multivariate analyses were performed to assess any significant differences between patient demographics, functional outcomes, quality of life, and severity of illness factors observed between medication regimens. PRINCIPAL FINDINGS: At admission, approximately half of the adults and one-third of the geriatric patients were taking an anti-manic agent. Of those not taking anti-manic agents, 70 percent of the adult patients and 57 percent of the geriatric patients were taking other psychotropic medications not identified as anti-manic or anti-psychotic medication. At discharge, the percentage of bipolar patients placed on anti-manic agents increased to 64% for adults and 55% for geriatric patients. Of concern, approximately 40% of adult and 50% of geriatric patients were not placed on any anti-manic agent despite their diagnosis. Results from the multivariate analyses indicated that adult bipolar patients who were taking Depakote and Zyprexa were significantly younger (39 versus 49 years) than those medicated with Depakote and Risperdal. Also, geriatric patients were significantly more likely to be taking Depakote plus Risperdal rather than Depakote plus a conventional anti-psychotic if they were Caucasian (100% versus 79%). CONCLUSIONS: These data suggest that practicing clinicians are not currently prescribing anti-manic agents for sizable proportions of patients with Primary Bipolar Disorder treated in inpatient settings. While the underlying reasons for these findings are unknown and in all likelihood complex, they may suggest that psychiatrists do not believe that the medications currently indicated for Bipolar Disorder, such as Depakote and Lithium are suitable treatment options, for many of these patients. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Relatively high rates of Zyprexa use alone were identified at discharge for patients with Bipolar Disorder. This suggests that clinicians in routine practice are viewing Zyprexa as a viable alternative to the standard anti-manic agents in the pharmacologic treatment of this disease.
Publication Types:
Keywords:
- Adult
- Aged
- Antimanic Agents
- Antipsychotic Agents
- Bipolar Disorder
- Demography
- Humans
- Lithium
- Lithium Carbonate
- Patient Discharge
- Pharmaceutical Preparations
- Prescriptions, Drug
- Psychiatry
- Psychotic Disorders
- Risperidone
- Valproic Acid
- diagnosis
- drug therapy
- therapy
- hsrmtgs
Other ID:
UI: 102194345
From Meeting Abstracts