Adherence of schizophrenia pharmacotherapy to published treatment recommendations: patient, facility, and provider predictors.

Very little is known about patient, provider, and facility characteristics that may affect the likelihood that a schizophrenia patient who receives an antipsychotic medication is dosed according to treatment recommendations. In this study, prescription drug records for schizophrenia patients were collected from the Department of Veterans Affairs, and indicators were constructed describing whether the average daily dose was outside of the range recommended by the schizophrenia Patient Outcomes Research Team (PORT). Generalized estimation equations were used to identify patient, facility, and provider characteristics that are associated with adherence to PORT recommendations. We found that the majority (62.1%) of patients were dosed within the PORT-recommended dosing range. Patients who were older, were female, had comorbid psychiatric disorders, or were prescribed conventional antipsychotics were less likely to adhere to PORT recommendations. Provider and facility characteristics were generally not significantly associated with adherence. When patients were dosed outside of the recommendations, patients treated at facilities with more emphasis on mental health and research and education were more likely to be dosed above the recommendations.