title: Predictors of antipsychotic medication change.
abstract: Atypical antipsychotics account for more than 60% of antipsychotic prescriptions written for the treatment of schizophrenia. While switching from one antipsychotic to another is a dynamic process, there has been no research on individual patient and institutional characteristics that predict antipsychotic switching. VA national administrative data were used to identify patients (n = 9660) with schizophrenia maintained on antipsychotic medication. Logistic regression was used to identify predictors of medication switching. Independent variables included information about service utilization, sociodemographic and clinical variables as well as institutional characteristics. This model was repeated for more specific switches between classes of medications and between specific medications. High levels of outpatient and inpatient service use were the most powerful predictors of switching. Sociodemographic, institutional, diagnostic, and functional measures were also predictive in some cases. Controlling for independent sociodemographic, diagnostic, and functional measures, frequency of clinical contact was the most robust predictor of switching antipsychotics.
authors.affiliation: Psychiatry Service, 116A, VA Connecticut Healthcare System, West Haven Campus, 950 Campbell Ave, West Haven, CT 06516, USA. michael.sernyak@yale.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sernyak
authors.forename: Douglas
authors.initials: D
authors.lastname: Leslie
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D019233:Retreatment; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012917:Social Adjustment; D012959:Socioeconomic Factors; D017211:Treatment Failure; D014600:Utilization Review / Q000706:statistics & numerical data
chemical_list: D014150:Antipsychotic Agents