title: Associations between adherence to guidelines for antipsychotic dose and health status, side effects, and patient care experiences.
abstract: BACKGROUND
  One approach to improving quality of care is to encourage physicians to follow evidence-based practice guidelines. Examples of evidence-based guidelines are the PORT recommendations for the treatment of schizophrenia. However, few studies have examined the relationship between adherence to guidelines and patient outcomes in clinical settings.
  
  
  OBJECTIVE
  The purpose of this article is to report the relationship between guideline adherence to antipsychotic medication dose and self-reported health status, side effects, and perceptions of care.
  
  
  METHODS
  This report is based on a subsample of patients from a larger prospective observational study of disabled Massachusetts Medicaid beneficiaries treated for schizophrenia.
  
  
  METHODS
  Participants were 329 acutely ill, vulnerable, high-risk Medicaid adult beneficiaries enrolled after visiting any 1 of 8 psychiatric emergency screening teams for hospital admission evaluation.
  
  
  METHODS
  Dose levels, symptoms, and functioning from medical records; self-reports as data collected from BASIS-32, SF-12, and CABHS; and paid health benefit claims for psychiatric treatment were measured.
  
  
  RESULTS
  Approximately 40% of the patients in this study had daily antipsychotic doses well above the recommended range, but there was no evidence that their health status was better than those on doses below 1000 CPZ units recommended for acute episodes. High-dose levels had no relationship to baseline symptom profile or referral source.
  
  
  CONCLUSIONS
  There was no evidence that health status was better on higher-than-recommended doses, but we cannot conclude that lower doses for some would have led to poorer outcomes. Physicians who believe that higher doses are more therapeutic for patients need to demand rigorous effectiveness research that tests whether there are benefits of higher doses and determine the ratio of those benefits to the clinical costs, including the risk of side effects.
authors.affiliation: Harvard Medical School and Cambridge Hospital, Cambridge, Massachusetts 02139, USA. barbara_dickey@hms.harvard.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Dickey
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Sue
authors.initials: S
authors.lastname: Eisen
authors.forename: Richard
authors.initials: R
authors.lastname: Hermann
authors.forename: Paul
authors.initials: P
authors.lastname: Cleary
authors.forename: Dharma
authors.initials: D
authors.lastname: Cortés
authors.forename: Norma
authors.initials: N
authors.lastname: Ware
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D011787:Quality of Health Care / Q000458:organization & administration; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents