title: Outcome assessment of an antipsychotic drug algorithm: effects of the Mississippi State Hospital algorithm project.
abstract: OBJECTIVE
  This study evaluated a state psychiatric hospital's algorithm for prescribing antipsychotic drugs for inpatients with schizophrenia to determine whether its emphasis on cost efficiency is compatible with quality of care.
  
  
  METHODS
  Outcomes were compared for patients who received medication that was algorithm adherent or nonadherent. Risperidone and ziprasidone were first-step oral antipsychotics. Documentation of clinical rationale was acceptable for nonpreferred drug use. Outcomes of interest were length of hospitalization and "much improved" or "very much improved" status on the Clinical Global Impression severity scale (CGI-S).
  
  
  RESULTS
  Of 401 patients, 70% were male. The CGI-S modal rating of severity was "markedly ill." Duration of illness was longer for patients given algorithm-nonadherent (17.6±9.7 years) versus -adherent (14.9±11.6 years, p=.013) medication. No statistically significant between-group differences were observed for mean length of stay (51.4±35.5 days versus 43.8±27.4 days, adjusted difference p=.18) or median improvement time (adherent, 41 days; nonadherent, 42 days; CI=34-48 days for both group medians).
  
  
  CONCLUSIONS
  Prescription algorithm adherence was not associated with significantly increased length of inpatient stay or delayed time to improvement.
authors.affiliation: Department of Pharmacy Practice, University of Mississippi, 2500 N. State St., Jackson, MS 39216, USA. crabtree@msh.state.ms.us
authors.forename: Brian L
authors.initials: BL
authors.lastname: Crabtree
authors.forename: Victor G
authors.initials: VG
authors.lastname: Dostrow
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Evans
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cuffel
authors.forename: Jose Ma J
authors.initials: JM
authors.lastname: Alvir
authors.forename: Kafi N
authors.initials: KN
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000465:Algorithms; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006783:Hospitals, State; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008922:Mississippi; D010879:Piperazines / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D011787:Quality of Health Care; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics; D013844:Thiazoles / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D013844:Thiazoles; C092292:ziprasidone; D018967:Risperidone