Antipsychotic medications are highly effective in schizophrenia. Controlled clinical research provides evidence for objective quality standards concerning the selection, dose, duration, and route of administration of antipsychotic medications. Yet, prescribing patterns vary widely, with many patients receiving medication regimens that are inconsistent with these standards. This presumably results in poorer patient outcomes. Surprisingly, very little is known about what has impeded translation of the research findings into clinical practice and why psychiatrists so often prescribe antipsychotic medications in a manner that is not supported by the research literature. This study tests a multidimensional model of medication management decision making. The model incorporates effects of the patient, provider, and treatment environment on the quality of antipsychotic medication management. The overall aim is to identify targets for quality improvement by defining specific critical points in the medication management decision-making process. The main study will have two phases. First, nationally representative survey data will be collected on the knowledge of antipsychotic medications, acceptance of guidelines, clinical confidence, motivation to change practice, and organizational and practice constraints of a randomly selected sample of 1,600 members of the American Psychiatric Association. In the second phase, the psychiatrists will provide information on the medication management and the clinical service and economic characteristics of three randomly selected patients with schizophrenia from their practices. The quality of medication management will be assessed by measuring conformance with treatment recommendations developed by the AHRQ/NIMH Schizophrenia Patient Outcomes Research Team (PORT). Information from both phases of the study will be used to identify specific modifiable patient, psychiatrist, and practice characteristics that promote or impede conformance with the treatment recommendations. The results will inform quality improvement programs by identifying key modifiable determinants of the quality of medication management in the community treatment of schizophrenia.
| Wilk, Joshua E; West, Joyce C; Marcus, Steven C et al. (2008) Family contact and the management of medication non-adherence in schizophrenia. Community Ment Health J 44:377-80 |
| Arbuckle, Melissa R; Gameroff, Marc J; Marcus, Steven C et al. (2008) Psychiatric opinion and antipsychotic selection in the management of schizophrenia. Psychiatr Serv 59:561-5 |
| Kreyenbuhl, Julie; Marcus, Steven C; West, Joyce C et al. (2007) Adding or switching antipsychotic medications in treatment-refractory schizophrenia. Psychiatr Serv 58:983-90 |
| Wilk, Joshua; Marcus, Steven C; West, Joyce et al. (2006) Substance abuse and the management of medication nonadherence in schizophrenia. J Nerv Ment Dis 194:454-7 |
