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 Citations (Scopus)

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

Fingerprint

olanzapine
Antipsychotic Agents
Schizophrenia
Risperidone
Veterans
Prescription Drugs
Clozapine
Budgets
Therapeutics
Pressure
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health

Cite this

@article{977f05d12dcc4db1828a3cdee7179afe,
title = "The effect of institutional fiscal stress on the use of atypical antipsychotic medications in the treatment of schizophrenia",
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.",
author = "Douglas Leslie and Robert Rosenheck",
year = "2001",
month = "7",
day = "5",
doi = "10.1097/00005053-200106000-00005",
language = "English (US)",
volume = "189",
pages = "377--383",
journal = "Journal of Nervous and Mental Disease",
issn = "0022-3018",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

The effect of institutional fiscal stress on the use of atypical antipsychotic medications in the treatment of schizophrenia. / Leslie, Douglas; Rosenheck, Robert.

In: Journal of Nervous and Mental Disease, Vol. 189, No. 6, 05.07.2001, p. 377-383.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The effect of institutional fiscal stress on the use of atypical antipsychotic medications in the treatment of schizophrenia

AU - Leslie, Douglas

AU - Rosenheck, Robert

PY - 2001/7/5

Y1 - 2001/7/5

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0034972851&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034972851&partnerID=8YFLogxK

U2 - 10.1097/00005053-200106000-00005

DO - 10.1097/00005053-200106000-00005

M3 - Article

C2 - 11434638

AN - SCOPUS:0034972851

VL - 189

SP - 377

EP - 383

JO - Journal of Nervous and Mental Disease

JF - Journal of Nervous and Mental Disease

SN - 0022-3018

IS - 6

ER -