Comparing the Quality of Pharmacotherapy for Schizophrenia in the VA and the Private Sector

Session number: 1053

Abstract title: Comparing the Quality of Pharmacotherapy for Schizophrenia in the VA and the Private Sector

Author(s):
DL Leslie - VA Connecticut MIRECC Northeast Program Evaluation Center Departments of Psychiatry and Epidemiology and Public Health, Yale School of Medicine
RA Rosenheck - VA Connecticut MIRECC Northeast Program Evaluation Center Departments of Psychiatry and Epidemiology and Public Health, Yale School of Medicine

Objectives: Pharmacotherapy is a cornerstone of effective treatment for schizophrenia. This study compares the quality of pharmacotherapy for schizophrenia in the VA with that in a sample of privately insured individuals.

Methods: All patients diagnosed with schizophrenia in the VA during fiscal year (FY) 1999 were identified using administrative data. In the private sector, a sample of patients diagnosed with schizophrenia in 1999 was identified using MEDSTAT’s MarketScan® database. For both groups, use of prescription medications was studied and measures of the quality of pharmacotherapy were constructed, including whether patients were prescribed an antipsychotic medication, whether they received multiple antipsychotic drugs (polypharmacy), and whether dosing adhered to established treatment guidelines. These measures were compared across the two groups, controlling for age, gender, and comorbid diagnoses.

Results: In the VA, 83% of patients with schizophrenia received an antipsychotic medication, compared to 64% in the private sector (p<0.0001). In both groups, only a small fraction of patients received polypharmacy (7% in the VA, 6% in the private sector), and the difference was not statistically significant. Patients in the VA were significantly more likely to de dosed above treatment guidelines, and significantly less likely to be dosed below treatment guidelines. Overall, 63% of VA patients with schizophrenia were dosed according to guidelines, compared with 67% in the private sector (p=0.02).

Conclusions: A significantly higher proportion of patients with schizophrenia were prescribed antipsychotic medication in the VA than in the private sector. With respect to other measures of the quality of schizophrenia pharmacotherapy, the differences between the two systems were mixed, with the VA outperforming the private sector on some measures, but doing worse with respect to others. Since VA patients are likely to be more severely ill than patients in the private sector, it is perhaps not surprising that they appear to be treated more aggressively (i.e. they more likely to be dosed above treatment guidelines).

Impact statement: Given the importance of pharmacotherapy in the treatment of schizophrenia, it is surprising that such a high fraction of patients in both the VA and the private sector diagnosed with schizophrenia do not receive these drugs.