Comparative Effectiveness Research (CER) compares benefits and risks of different treatments. However, little is known about the impact of large-scale CER implementation as conceived in the 2010 Affordable Care Act (ACA) on equity in health care across racial/ethnic groups. Identifying the influence of FDA risk warnings on disparities in psychotropic drug use provides a platform to understand how CER will influence disparities in certain situations. Disparity methods have typically not taken into account specific recommendations and warnings on effectiveness and safety. With the advent of the ACA and continued concern over persistent disparities, it is imperative that disparities research continues to evolve to incorporate lessons learned from CER. We capitalize upon time trends in warnings and advisories to understand disparities in diffusion with the intention of identifying policies tht might avert the negative equity consequences of incorporating CER into routine practice. Specifically, we 1) Track changes in antidepressant use among youth and antipsychotic drug use among youth and adults by racial/ethnic group as they are influenced by CER-generated risk warnings and advisories;2) Assess whether specific information in FDA warnings influenced disparity trends in a) treatments recommended by CER-generated evidence (e.g., fluoxetine use and metabolic screening for antipsychotic users);and b) psychotropic drug use that is potentially harmful (e.g., olanzapine use);and 3) Identify how provider characteristics an HMO enrollment act as mechanisms that underlie the differential diffusion of CER via health risk warnings. We implement the Institute of Medicine (IOM) definition of healthcare disparities in order to capture trends in disparities over time, overlaying timelines of warnings and recommendations related to antidepressant and antipsychotic drugs. We adapt IOM methods by decomposing disparities in overall drug use into disparities in specific categories of use mentioned by FDA warnings as carrying particular risk or benefit. If we find racial/ethnic disparities in diffusion of risk warnings and advisories, this suggests policymakers should focus on improving uptake of CER among minorities. If we identify that certain providers and HMO membership influences disparities in diffusion, this will lead to recommendations for policymakers of actionable policies to avert the negative equity consequences of incorporating CER into routine practice.

Public Health Relevance

In this proposed project, we intend to examine whether specific information in FDA warnings influenced disparity trends in psychotropic drug use and mental health care and to identify how provider characteristics and HMO enrollment act as mechanisms that underlie the differential diffusion of CER via health risk warnings. Identifying the influence of FDA risk warnings on trends in psychotropic drug use and related health care provides a platform to understand how CER will influence disparities and will help us to assess whether information regarding the risks and benefits of medications are being equitably disseminated. Our examination of how an increased reliance on CER will likely influence disparities in treatment after health care reform will provide policymakers with actionable information that might avert the negative equity consequences of incorporating CER into routine practice.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS021486-01A1
Application #
8578898
Study Section
Health Systems Research (HSR)
Program Officer
Hsia, David
Project Start
2013-07-10
Project End
2016-06-30
Budget Start
2013-07-10
Budget End
2014-06-30
Support Year
1
Fiscal Year
2013
Total Cost
Indirect Cost
Name
Cambridge Health Alliance
Department
Type
DUNS #
805262995
City
Cambridge
State
MA
Country
United States
Zip Code
02139
Kafali, Nilay; Progovac, Ana; Hou, Sherry Shu-Yeu et al. (2018) Long-Run Trends in Antidepressant Use Among Youths After the FDA Black Box Warning. Psychiatr Serv 69:389-395
Cook, Benjamin; Creedon, Timothy; Wang, Ye et al. (2018) Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse. Drug Alcohol Depend 187:29-34
Cook, Benjamin Lê; Carson, Nicholas J; Kafali, E Nilay et al. (2017) Examining psychotropic medication use among youth in the U.S. by race/ethnicity and psychological impairment. Gen Hosp Psychiatry 45:32-39
Carson, Nicholas J; Progovac, Ana M; Wang, Ye et al. (2017) A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills. Depress Anxiety 34:1147-1156
Kim, Giyeon; Dautovich, Natalie; Ford, Katy-Lauren et al. (2017) Geographic variation in mental health care disparities among racially/ethnically diverse adults with psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 52:939-948
Cook, Benjamin Lê; Trinh, Nhi-Ha; Li, Zhihui et al. (2017) Trends in Racial-Ethnic Disparities in Access to Mental Health Care, 2004-2012. Psychiatr Serv 68:9-16
Cook, Benjamin L; Zuvekas, Samuel H; Chen, Jie et al. (2017) Assessing the Individual, Neighborhood, and Policy Predictors of Disparities in Mental Health Care. Med Care Res Rev 74:404-430
Creedon, Timothy B; Cook, Benjamin Lê (2016) Access To Mental Health Care Increased But Not For Substance Use, While Disparities Remain. Health Aff (Millwood) 35:1017-21
Cook, Benjamin L; Kim, Giyeon; Morgan, Kari Lock et al. (2016) Measuring Geographic ""Hot Spots"" of Racial/Ethnic Disparities: An Application to Mental Health Care. J Health Care Poor Underserved 27:663-84
Saloner, Brendan; Lê Cook, Benjamin (2014) An ACA provision increased treatment for young adults with possible mental illnesses relative to comparison group. Health Aff (Millwood) 33:1425-34