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May 30, 2018

Objective: To explore the antpsychotic medications prescribing practices for patients discharged from state psychiatric facilities by age stratification.

Method: Cross-sectional analysis of all discharges reported for the Facility-Based Inpatient Psychiatric Services (HBIPS) measures from state psychiatric facilities from January 1 through December 31, 2011. Discharges were extracted from the NRI’s Behavioral Healthcare Performance Measurement System. Descriptive analyses were performed to determine the unadjusted and adjusted rates of antipsychotic medication prescribing practices by age and by region, the reasons for discharging patients on antipsychotic polypharmacy, and the polypharmacy rates by facility. Age stratification was investigated for youth ages 13 – 17 years and for adults ages 18 – 64 years. 

Results: Overall, 91,547 discharges were included for comparison analyses. The prevalence of antipsychotic polypharmacy was one-third as many for youth than for adults (4% versus 12%) (unadjusted polypharmacy rate). The adjusted antipsychotic polypharmacy rate for youth was two and a half the adjusted polypharmacy rate of adults (7% versus 18%). For adults, the Northeast region (20%) had the highest proportion of patients discharged on antipsychotic polypharmacy while for youths was the Midwest region (7%). For both youth and adults, the top reason for being discharged on antipsychotic polypharmacy was for symptoms reduction. For facilities serving youth, the rate of antipsychotic polypharmacy ranged from 0% to 24%. For facilities serving adults, the rate of antipsychotic polypharmcy ranged from 0% to 57%.

Conclusion: Disparate antipsychotic polyphamacy rates were observed for both, facilities serving youth and facilities serving adults, and by region, highlighting opportunities for quality improvement. In general, there was an increasing trend in the practice of discharging patients on antipsychotic polypharmacy as age increased.  This may inform age-specific interventions that can be transitioned with the patients as they move from youth life to adulthood that may have an impact on the antipsychotic polypharmacy rates.