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USING MEDICAID CLAIMS AND DOSING GUIDELINES TO ASSESS THE PRESCRIBING AND OUTCOMES OF CONVENTIONAL ANTIPSYCHOTICS
Nathaniel M Rickles and Bonnie L Svarstad

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BACKGROUND: While newer atypical antipsychotics are considered the treatment of choice for schizophrenia, it is important to study dosing guidelines for conventional antipsychotics as they continue to be used alone or in combination with newer agents for patients who are refractory to treatment with newer agents. Few studies have used Medicaid claims for this purpose, even though they provide a readily available and objective means of assessing dosing in relation to guidelines and outcomes of prescribing.

OBJECTIVE: To examine a new multi-method approach for studying dosing guidelines and outcomes of prescribing in Medicaid recipients receiving conventional antipsychotics.

METHODS: Data were collected from medical records, Medicaid prescription and hospital claims, and case managers in 8 county-based delivery systems in Wisconsin during a 12-month period in 1989–1990 as a part of a larger naturalistic study. Eligible patients had a primary diagnosis of schizophrenia, a prescription for oral antipsychotics, and no hospitalizations during baseline (first quarter).

RESULTS: Of 159 patients, 46.5%, 32.1%, and 21.4% had baseline antipsychotic doses below, above, and within the guidelines, respectively. Patients dosed above the guidelines were 4 times more likely to be hospitalized after baseline (p < 0.05) than those within the guidelines after controlling for adherence, baseline functioning, and past hospitalizations. Further analysis showed that the high-dose/hospitalization relationship was mediated or explained in part by adverse effects.

CONCLUSIONS: The use of Medicaid claims revealed a substantial amount of prescribing outside of guidelines and an increased risk of hospitalization during the study period. Future trials are needed to compare this methodologic approach with other approaches and to determine whether current dosing patterns and outcomes have changed.

J Pharm Technol 2002;19:146-53.

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