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dc.contributor.authorMiller, Christopher J.
dc.contributor.authorLi, Mingfei
dc.contributor.authorPenfold, Robert B.
dc.contributor.authorLee, Austin F.
dc.contributor.authorSmith, Eric G.
dc.contributor.authorOsser, David N.
dc.contributor.authorBajor, Laura
dc.contributor.authorBauer, Mark S.
dc.date2022-08-11T08:09:42.000
dc.date.accessioned2022-08-23T16:40:35Z
dc.date.available2022-08-23T16:40:35Z
dc.date.issued2014-11-30
dc.date.submitted2015-06-01
dc.identifier.citationBMC Psychiatry. 2014 Nov 30;14:339. doi: 10.1186/s12888-014-0339-z. <a href="http://dx.doi.org/10.1186/s12888-014-0339-z">Link to article on publisher's site</a>
dc.identifier.issn1471-244X (Linking)
dc.identifier.doi10.1186/s12888-014-0339-z
dc.identifier.pmid25433807
dc.identifier.urihttp://hdl.handle.net/20.500.14038/39711
dc.description.abstractBACKGROUND: Several second generation antipsychotics (SGAs) received FDA approval for bipolar disorder in the 2000s. Although efficacious, they have been costly and may cause significant side effects. Little is known about the factors associated with prescribers' decisions to initiate SGA prescriptions for this condition. METHODS: We gathered administrative data from the Department of Veterans Affairs on 170,713 patients with bipolar disorder between fiscal years 2003-2010. Patients without a prior history of taking SGAs were considered eligible for SGA initiation during the study (n =126,556). Generalized estimating equations identified demographic, clinical, and comorbidity variables associated with initiation of an SGA prescription on a month-by-month basis. RESULTS: While the number of patients with bipolar disorder using SGAs nearly doubled between 2003 and 2010, analyses controlling for patient characteristics and the rise in the bipolar population revealed a 1.2% annual decline in SGA initiation during this period. Most medical comorbidities were only modestly associated with overall SGA initiation, although significant differences emerged among individual SGAs. Several markers of patient severity predicted SGA initiation, including previous hospitalizations, psychotic features, and a history of other antimanic prescriptions; these severity markers became less firmly linked to SGA initiation over time. Providers in the South were somewhat more likely to initiate SGA treatment. CONCLUSIONS: The number of veterans with bipolar disorder prescribed SGAs is rising steadily, but this increase appears primarily driven by a corresponding increase in the bipolar population. Month-by-month analyses revealed that higher illness severity predicted SGA initiation, but that this association may be weakening over time.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=25433807&dopt=Abstract">Link to Article in PubMed</a>
dc.rights<p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<a href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</a>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</p>
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectHealth Services Administration
dc.subjectMental Disorders
dc.subjectPsychiatric and Mental Health
dc.subjectPsychiatry
dc.titlePatterns of initiation of second generation antipsychotics for bipolar disorder: a month-by-month analysis of provider behavior
dc.typeJournal Article
dc.source.journaltitleBMC psychiatry
dc.source.volume14
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=3512&amp;context=oapubs&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/oapubs/2509
dc.identifier.contextkey7161382
refterms.dateFOA2022-08-23T16:40:35Z
html.description.abstract<p>BACKGROUND: Several second generation antipsychotics (SGAs) received FDA approval for bipolar disorder in the 2000s. Although efficacious, they have been costly and may cause significant side effects. Little is known about the factors associated with prescribers' decisions to initiate SGA prescriptions for this condition.</p> <p>METHODS: We gathered administrative data from the Department of Veterans Affairs on 170,713 patients with bipolar disorder between fiscal years 2003-2010. Patients without a prior history of taking SGAs were considered eligible for SGA initiation during the study (n =126,556). Generalized estimating equations identified demographic, clinical, and comorbidity variables associated with initiation of an SGA prescription on a month-by-month basis.</p> <p>RESULTS: While the number of patients with bipolar disorder using SGAs nearly doubled between 2003 and 2010, analyses controlling for patient characteristics and the rise in the bipolar population revealed a 1.2% annual decline in SGA initiation during this period. Most medical comorbidities were only modestly associated with overall SGA initiation, although significant differences emerged among individual SGAs. Several markers of patient severity predicted SGA initiation, including previous hospitalizations, psychotic features, and a history of other antimanic prescriptions; these severity markers became less firmly linked to SGA initiation over time. Providers in the South were somewhat more likely to initiate SGA treatment.</p> <p>CONCLUSIONS: The number of veterans with bipolar disorder prescribed SGAs is rising steadily, but this increase appears primarily driven by a corresponding increase in the bipolar population. Month-by-month analyses revealed that higher illness severity predicted SGA initiation, but that this association may be weakening over time.</p>
dc.identifier.submissionpathoapubs/2509
dc.contributor.departmentDepartment of Psychiatry
dc.source.pages339


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<p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<a href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</a>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</p>
Except where otherwise noted, this item's license is described as <p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<a href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</a>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</p>