Variation of Clozapine Use for Treatment of Schizophrenia: Evidence from Pennsylvania Medicaid and Dually Eligible Enrollees.
Clozapine
Medicaid
Medicare
Schizophrenia
Journal
Community mental health journal
ISSN: 1573-2789
Titre abrégé: Community Ment Health J
Pays: United States
ID NLM: 0005735
Informations de publication
Date de publication:
05 2024
05 2024
Historique:
received:
20
09
2023
accepted:
26
12
2023
medline:
9
4
2024
pubmed:
31
1
2024
entrez:
31
1
2024
Statut:
ppublish
Résumé
While clozapine is the most effective antipsychotic treatment for treatment-resistant schizophrenia, it remains underutilized across the United States, warranting a more comprehensive understanding of variation in use at the county level, as well as characterization of existing prescribing patterns. Here, we examined both Medicaid and Medicare databases to (1) characterize temporal and geographic variation in clozapine prescribing and, (2) identify patient-level characteristics associated with clozapine use. We included Medicaid and Fee for Service Medicare data in the state of Pennsylvania from January 1, 2013, through December 31, 2019. We focused on individuals with continuous enrollment, schizophrenia diagnosis, and multiple antipsychotic trials. Geographic variation was examined across counties of Pennsylvania. Regression models were constructed to determine demographic and clinical characteristics associated with clozapine use. Out of 8,255 individuals who may benefit from clozapine, 642 received treatment. We observed high medication burden, overall, including multiple antipsychotic trials. We also identified variation in clozapine use across regions in Pennsylvania with a disproportionate number of prescribers in urban areas and several counties with no identified clozapine prescribers. Finally, demographic, and clinical determinants of clozapine use were observed including less use in people identified as non-Hispanic Black, Hispanic, or with a substance use disorder. In addition, greater medical comorbidity was associated with increased clozapine use. Our work leveraged both Medicaid and Medicare data to characterize and surveil clozapine prescribing. Our findings support efforts monitor disparities and opportunities for the optimization of clozapine within municipalities to enhance clinical outcomes.
Identifiants
pubmed: 38294579
doi: 10.1007/s10597-023-01226-7
pii: 10.1007/s10597-023-01226-7
doi:
Substances chimiques
Clozapine
J60AR2IKIC
Antipsychotic Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
743-753Subventions
Organisme : NIMH NIH HHS
ID : R01 MH124705
Pays : United States
Organisme : NIMH NIH HHS
ID : R21 MH134128
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA048029
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA055585
Pays : United States
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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