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Brief Reports   |    
State and Demographic Variation in Use of Depot Antipsychotics by Medicaid Beneficiaries With Schizophrenia
Jonathan D. Brown, Ph.D., M.H.S.; Allison Barrett, M.A.; Emily Caffery, B.A.; Kerianne Hourihan, B.Sc., B.A.; Henry T. Ireys, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300001
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The authors are affiliated with Mathematica Policy Research. Dr. Brown, Ms. Barrett, and Dr. Ireys are with the Washington, D.C., office, Ms. Caffery is with the Ann Arbor, Michigan, office, and Ms. Hourihan is with the Cambridge, Massachusetts, office (e-mail: jbrown@mathematica-mpr.com).

Copyright © 2014 by the American Psychiatric Association


Objective  This study examined state and demographic variation in use of depot antipsychotics among Medicaid beneficiaries with schizophrenia.

Method  Medicaid claims data (2007) from 21 states and the District of Columbia were analyzed for 102,884 beneficiaries age 18 to 64 with schizophrenia. Rates of receipt of depot antipsychotics were determined for all beneficiaries and for African Americans, Caucasians, and beneficiaries from “all other races.”

Results  Across study states, a mean of 10% of beneficiaries with schizophrenia received depot antipsychotics. Rates ranged from 1.9% in the District of Columbia to 20.9% in Alabama. In 12 states, African Americans were disproportionately likely to receive these medications compared with beneficiaries of other races.

Conclusions  Use of depot antipsychotics varied across state Medicaid programs. African Americans received a disproportionate share in many states. Further research is needed to understand the sources of such variation. These findings underscore the need to monitor the use of depot antipsychotics.

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Table 1Receipt of depot antipsychotics among 102,884 Medicaid beneficiaries with schizophrenia in 21 states and the District of Columbia, by racial-ethnic group
Table Footer Note

a Denominator is all beneficiaries with schizophrenia in each racial group for each state. Data are not reported (nr) for states with fewer than 100 beneficiaries with schizophrenia in a given racial group.

Table Footer Note

b Denominator is beneficiaries with schizophrenia who received depot antipsychotics in each state. Data are not reported (nr) for states with fewer than 100 beneficiaries receiving depot antipsychotics in a given racial group.

Table Footer Note

c “Other” includes Hispanic, American Indian and Native American, and unknown. The number of beneficiaries in these groups was too small to analyze separately.

Table Footer Note

d Percentage point difference from the racial distribution of the Medicaid population with schizophrenia



Patel  MX;  David  AS:  Why aren’t depot antipsychotics prescribed more often and what can be done about it?  Advances in Psychiatric Treatment 11:203–213, 2005
Roberts  LW;  Geppert  CMA:  Ethical use of long-acting medications in the treatment of severe and persistent mental illnesses.  Comprehensive Psychiatry 45:161–167, 2004
[CrossRef] | [PubMed]
Kuno  E;  Rothbard  AB:  Racial disparities in antipsychotic prescription patterns for patients with schizophrenia.  American Journal of Psychiatry 159:567–572, 2002
[CrossRef] | [PubMed]
Valenstein  M;  Copeland  LA;  Owen  R  et al:  Adherence assessments and the use of depot antipsychotics in patients with schizophrenia.  Journal of Clinical Psychiatry 62:545–551, 2001
[CrossRef] | [PubMed]
Brown JD, Barrett A, Ireys HT, et al: Evidence-Based Practices for Medicaid Beneficiaries With Schizophrenia and Bipolar Disorder. Report prepared for the US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Washington, DC, Mathematica Policy Research, April 2012
Simon  GE;  Unützer  J:  Health care utilization and costs among patients treated for bipolar disorder in an insured population.  Psychiatric Services 50:1303–1308, 1999
Ascher-Svanum  H;  Zhu  B;  Faries  DE  et al:  Medication adherence levels and differential use of mental-health services in the treatment of schizophrenia.  BMC Research Notes 2:6, 2009
[CrossRef] | [PubMed]
West  JC;  Marcus  SC;  Wilk  J  et al:  Use of depot antipsychotic medications for medication nonadherence in schizophrenia.  Schizophrenia Bulletin 34:995–1001, 2008
[CrossRef] | [PubMed]
Taylor  DM:  Is Cost a Factor? A Survey of Psychiatrists and Health Authorities to Determine the Factors Influencing the Prescribing and Funding of Atypical Antipsychotics .  London,  National Schizophrenia Fellowship Publications, 1999
Citrome  L;  Levine  J;  Allingham  B:  Utilization of depot neuroleptic medication in psychiatric inpatients.  Psychopharmacology Bulletin 32:321–326, 1996
Segal  SP;  Bola  JR;  Watson  MA:  Race, quality of care, and antipsychotic prescribing practices in psychiatric emergency services.  Psychiatric Services 47:282–286, 1996
Shi  L;  Ascher-Svanum  H;  Zhu  B  et al:  Characteristics and use patterns of patients taking first-generation depot antipsychotics or oral antipsychotics for schizophrenia.  Psychiatric Services 58:482–488, 2007
[CrossRef] | [PubMed]
Kuno  E;  Rothbard  AB:  The effect of income and race on quality of psychiatric care in community mental health centers.  Community Mental Health Journal 41:613–622, 2005
[CrossRef] | [PubMed]
Price  N;  Glazer  W;  Morgenstern  H:  Demographic predictors of the use of injectable versus oral antipsychotic medications in outpatients.  American Journal of Psychiatry 142:1491–1492, 1985
Kreyenbuhl  J;  Zito  JM;  Buchanan  RW  et al:  Racial disparity in the pharmacological management of schizophrenia.  Schizophrenia Bulletin 29:183–193, 2003
[CrossRef] | [PubMed]
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