The effect of institutional fiscal stress on the use of atypical antipsychotic medications in the treatment of schizophrenia

Douglas Leslie, Robert Rosenheck

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

This paper examines the effects of medical center budget stress on the use of expensive atypical antipsychotic medications for the treatment of schizophrenia in the Department of Veterans Affairs (VA). VA prescription drug records were collected for patients diagnosed with schizophrenia. Generalized estimation equations were used to identify patient and facility characteristics (especially fiscal stress) that are associated with the use of atypical antipsychotics. Of the 34,925 patients in the final sample, over half received an atypical antipsychotic, usually either olanzapine or risperidone. Unexpectedly, increased fiscal stress was associated with increased likelihood of receiving atypical antipsychotics. Among patients who receive atypicals, however, fiscal stress was associated with reduced likelihood of receiving the more expensive atypicals (clozapine and olanzapine) but positively associated with receiving the least expensive atypical (risperidone). Institutional fiscal pressure does not seem to reduce the broad availability of these medications overall but does affect which drug is prescribed.

Original languageEnglish (US)
Pages (from-to)377-383
Number of pages7
JournalJournal of Nervous and Mental Disease
Volume189
Issue number6
DOIs
StatePublished - Jul 5 2001

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health

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