Patterns of initiation of second generation antipsychotics for bipolar disorder: a month-by-month analysis of provider behavior

BMC Psychiatry

Mark S Bauer¹  Laura Bajor⁷  David N Osser³  Eric G Smith⁵  Austin F Lee⁶  Robert B Penfold²  Mingfei Li⁴  Christopher J Miller⁷ 

[1] Department of Psychiatry, Harvard Medical School, Boston, MA, USA;Department of Health Services Research, University of Washington, Seattle, WA, USA;VA Boston Healthcare System, Brockton, MA, USA;Department of Mathematical Sciences, Bentley University, Waltham, MA, USA;Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA;Massachusetts General Hospital, Boston, MA, USA;The Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA

关键词: Veterans;    Antipsychotics;    Bipolar disorder;   

Others  :  1091868
DOI  :  10.1186/s12888-014-0339-z

 received in 2014-03-14, accepted in 2014-11-17,  发布年份 2014

【 摘 要 】

Background

Several second generation antipsychotics (SGAs) received FDA approval for bipolar disorder in the 2000s. Although efficacious, they have been costly and may cause significant side effects. Little is known about the factors associated with prescribers’ decisions to initiate SGA prescriptions for this condition.

Methods

We gathered administrative data from the Department of Veterans Affairs on 170,713 patients with bipolar disorder between fiscal years 2003–2010. Patients without a prior history of taking SGAs were considered eligible for SGA initiation during the study (n =126,556). Generalized estimating equations identified demographic, clinical, and comorbidity variables associated with initiation of an SGA prescription on a month-by-month basis.

Results

While the number of patients with bipolar disorder using SGAs nearly doubled between 2003 and 2010, analyses controlling for patient characteristics and the rise in the bipolar population revealed a 1.2% annual decline in SGA initiation during this period. Most medical comorbidities were only modestly associated with overall SGA initiation, although significant differences emerged among individual SGAs. Several markers of patient severity predicted SGA initiation, including previous hospitalizations, psychotic features, and a history of other antimanic prescriptions; these severity markers became less firmly linked to SGA initiation over time. Providers in the South were somewhat more likely to initiate SGA treatment.

Conclusions

The number of veterans with bipolar disorder prescribed SGAs is rising steadily, but this increase appears primarily driven by a corresponding increase in the bipolar population. Month-by-month analyses revealed that higher illness severity predicted SGA initiation, but that this association may be weakening over time.

【 授权许可】

   
2014 Miller et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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