Monday, October 4, 2021

Wide Racial and Geographic Disparities Found in Clozapine and LAI Prescriptions

Regional and racial variations in the prescribing of psychotropic medications to patients with schizophrenia may underlie some of the health inequities associated with these disorders, reports a study in Psychiatric Services in Advance.

“The most dramatic interstate differences were in prescription of clozapine and LAIs [long-acting injectable antipsychotics], which have distinctive roles in medication management,” wrote Natalie Bareis, L.M.S.W., Ph.D., of Columbia University and colleagues. “[C]lozapine has efficacy in managing treatment-resistant schizophrenia and reducing suicidal behaviors and has low rates of prescription by clinicians, and LAI medications address nonadherence, but they require clinician administration and pose risks for coercion.”

Specifically, non-Hispanic Blacks and people of other race-ethnic groups were more likely than non-Hispanic Whites to fill prescriptions for LAIs, whereas non-Hispanic Whites were more likely than all other groups to fill prescriptions for clozapine.

Bareis and colleagues used the national Medicaid Analytic eXtract databases to compile data on adults aged 18 to 64 who had been diagnosed with schizophrenia or schizoaffective disorder in 2011 and filled at least one 15-day prescription for an oral antipsychotic, antidepressant, benzodiazepine, or mood stabilizer or one prescription for an injectable LAI in 2012. Their sample included 357,914 adults from 47 states plus the District of Columbia (Hawaii, Idaho, and Maine had missing data and were not included).

The analysis showed wide ranges in psychotropic prescriptions across states. For example, the percentage of patients receiving LAIs ranged from 4% in Colorado to 22% in Rhode Island, while the percentage of patients receiving clozapine ranged from 1% in Nevada to 11% in South Dakota. Prescriptions for other psychotropics also varied geographically.

There were also significant variations at the patient level:

  • Non-Hispanic Blacks were 39% more likely to be given an LAI compared with non-Hispanic Whites and 60% less likely to be given clozapine.
  • Hispanics were 26% more likely to be given an LAI compared with non-Hispanic Whites and 37% less likely to be given clozapine.
  • Native Hawaiians/Pacific Islanders were 26% more likely to be given an LAI compared with non-Hispanic Whites and 20% less likely to be given clozapine.
  • Asians had similar rates of LAI prescriptions as non-Hispanic Whites, but 17% less likely to be given clozapine.
  • Non-Hispanic Whites were more likely to receive prescriptions for non-antipsychotic medications than all other ethnic groups.

“Psychiatric training that is culturally sensitive and seeks to minimize disparities by race or ethnicity and that requires competency in the prescription of clozapine and LAI antipsychotic medications may reduce variation,” Bareis and colleagues wrote. “A better understanding of the causes of wide variation in LAI and clozapine prescriptions is needed to improve access to these important treatment options.”

To read more on this topic, see the Psychiatric News article, “More Minority Patients May Be Able to Safely Use Clozapine.”

(Image: iStock/Olivier Le Moal)

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