Race and Long-Acting Antipsychotic Prescription at a Community Mental Health Center: A Retrospective Chart Review

Objective: There has been concern that racial minorities are disproportionately prescribed long-acting injectable antipsychotic drugs. Method: Comprehensive administrative data and clinician survey were used to identify all patients with a DSM-IV diagnosis of schizophrenia who received long-acting antipsychotic prescriptions from July 2009 to June 2010 at a community mental health center. Charts were reviewed retrospectively to validate long-acting antipsychotic prescription (eg, medication, dosage) and merged with administrative data from all center patients documenting sociodemographic characteristics (ie, age, race, gender) and comorbid diagnoses. We used bivariate X-2, t tests, and multivariate logistic regression to compare the subsample of patients receiving long-acting injectable drugs (n=102) to patients not receiving long-acting injectable drugs (n=799) who were diagnosed with schizophrenia for the same period. Results: White patients were significantly less likely to receive long-acting antipsychotic prescriptions than minority patients (OR=0.52, P<.007); ie, nonwhites were 1.89 times more likely to receive such drugs. Age, gender, and comorbid diagnoses, including substance abuse, were unrelated to long-acting injectable prescription, and race/ethnicity was not associated with use of specific agents (haloperidol decanoate, fluphenazine decanoate, or risperidone microspheres) (P=.73). Conclusions: Racial minorities are more likely than other patients with schizophrenia to receive long-acting injectionable antipsychotics, a finding that suggests their prescribers may consider them less adherent to antipsychotic prescriptions. J Clin Psychiatry 2012;73 (4):513-517 (C) Copyright 2012 Physicians Postgraduate Press, Inc.