Research in Social and Administrative Pharmacy
Volume 5, Issue 3 , Pages 234-241, September 2009

Concomitant antipsychotic prescribing in US outpatient settings

  • Rajender R. Aparasu, Ph.D

      Affiliations

    • Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, 1441 Moursund Street, Texas Medical Center, Houston, TX 77030, USA
    • Corresponding Author InformationCorresponding author. Tel.: +713 7959374.
    • ,
  • Elda Jano, B.S

      Affiliations

    • Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, TX 77030, USA
    • ,
  • Vinod Bhatara, M.D, M.S

      Affiliations

    • Department of Psychiatry, University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57105, USA

published online 22 January 2009.

Abstract 

Background

Clinicians use concomitant antipsychotic therapy for management of psychotic disorders despite a paucity of evidence for this practice.

Objective

To examine national patterns and determinants of concomitant antipsychotic therapy.

Methods

Concomitant antipsychotic therapy was defined as simultaneous use of 2 or more antipsychotic agents. Prescription data from the 2003-2004 National Ambulatory Medical Care Survey and the outpatient department portion of the 2003-2004 National Hospital Ambulatory Medical Care Survey were used to characterize the prescribing of concomitant antipsychotic therapy and antipsychotic monotherapy (defined as use of a typical or atypical agent). Multiple logistic regression was applied to antipsychotic visits to examine the determinants of concomitant antipsychotic therapy based on patient and provider characteristics.

Results

Overall, concomitant antipsychotic therapy was documented in 9% of the visits involving antipsychotic agents, and monotherapy in 91% of the visits. The use of atypical agents, namely risperidone, olanzapine, and quetiapine, was common in both forms of therapy. Concomitant therapy was frequently used for psychoses and bipolar disorder. Logistic regression revealed that the odds of receiving concomitant antipsychotic therapy were higher for patients younger than 65 years, with greatest odds (odds ratio=6.52) for patients 40 to 64 years old. Having a diagnosis of psychosis quadrupled (odds ratio=4.33) the odds of receiving concomitant antipsychotic therapy. Physicians in metropolitan areas were more likely (odds ratio=2.17) to use concomitant antipsychotic therapy than physicians in non-metropolitan areas.

Conclusions

Concomitant antipsychotic therapy continues to be prevalent and extensive in outpatient settings. With the use of concomitant antipsychotic therapy as a quality of care measure, there is a need to optimize prescribing of these potent combinations.

Keywords: Antipsychotic, Atypical, Concomitant, Polypharmacy, Psychosis

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 The authors have no relevant financial interest to declare. No funding was received for this study.

 Presented in part at the 2007 Annual Meeting of the American Pharmacists Association, Atlanta, GA, March 2007.

PII: S1551-7411(08)00091-0

doi:10.1016/j.sapharm.2008.08.005

Research in Social and Administrative Pharmacy
Volume 5, Issue 3 , Pages 234-241, September 2009

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