退伍军人事务部医疗保健系统中无家可归和住房不稳定的退伍军人的抗精神病药物处方。

Antipsychotic Medication Prescriptions for Homeless and Unstably Housed Veterans in the Veterans Affairs Health Care System.

机构信息

7411 John Smith Drive, Ste 1100, San Antonio, TX 78229.

National Center on Homelessness Among Veterans, Homeless Program Office, US Department of Veterans Affairs, Tampa, Florida, USA.

出版信息

J Clin Psychiatry. 2020 Dec 8;82(1):20m13372. doi: 10.4088/JCP.20m13372.

DOI:10.4088/JCP.20m13372

PMID:33296148

Abstract

OBJECTIVE

Many homeless and unstably housed (HUH) adults have severe mental illnesses that are managed with antipsychotic medications. The US Department of Veterans Affairs (VA) is the largest provider of homeless services, but there has been little study of psychotropic medication prescriptions for HUH veterans.

METHODS

Using national VA administrative data in 2017, rates and characteristics associated with prescriptions for antipsychotic medications for veterans using VA health care services (N = 2,882,993), including HUH veterans (n = 266,855), were analyzed.

RESULTS

Among HUH veterans, 17.6% had an antipsychotic prescription within 1 year of indication of HUH and 4.3% had prescriptions for 3 or more antipsychotic medications, which was higher than the 2.2% of non-HUH veterans with 3 or more antipsychotic prescriptions. Controlling for sociodemographic and clinical characteristics, HUH veterans were more than 3 times as likely to have an antipsychotic prescription as other veterans. However, among HUH veterans with an ICD-10-documented psychotic or bipolar disorder, HUH veterans were less likely to have prescriptions for first-generation and second-generation antipsychotics compared to their non-HUH counterparts (odds ratios for any antipsychotic < 0.5). Less than 2% of both HUH and non-HUH veterans had received long-acting injectable second-generation antipsychotic medications, and less than 0.2% were on clozapine treatment.

CONCLUSIONS

These findings provide a snapshot of antipsychotic prescription practices for HUH veterans in the VA health care system. The higher rates of antipsychotic prescriptions for HUH veterans overall, but potential underprescribing of antipsychotics for HUH veterans with severe mental illness, suggest there are opportunities for improving antipsychotic prescription practices in this population, including increasing use of long-acting injectable medications.

摘要

目的

许多无家可归和住房不稳定的（HUH）成年人患有严重的精神疾病，这些疾病通过抗精神病药物来治疗。美国退伍军人事务部（VA）是无家可归服务的最大提供者，但对 HUH 退伍军人的精神药物处方几乎没有研究。

方法

使用 2017 年国家 VA 行政数据，分析了接受 VA 医疗服务的退伍军人（N=2,882,993），包括 HUH 退伍军人（n=266,855）的抗精神病药物处方的发生率和特征。

结果

在 HUH 退伍军人中，有 17.6%的人在 HUH 出现后一年内有抗精神病药物处方，有 4.3%的人有 3 种或更多的抗精神病药物处方，高于非 HUH 退伍军人中有 2.2%的人有 3 种或更多的抗精神病药物处方。在控制了社会人口统计学和临床特征后，与其他退伍军人相比，HUH 退伍军人有抗精神病药物处方的可能性高出 3 倍以上。然而，在 HUH 退伍军人中有 ICD-10 记录的精神病或双相情感障碍患者中，与非 HUH 退伍军人相比，他们服用第一代和第二代抗精神病药物的可能性较低（任何抗精神病药物的比值比<0.5）。不到 2%的 HUH 和非 HUH 退伍军人接受了第二代长效注射用抗精神病药物治疗，不到 0.2%的退伍军人接受了氯氮平治疗。