Potential Disparities in the Management of Schizophrenia in the United States

OBJECTIVE: This study investigated whether outpatient visits to psychiatrists and primary care physicians (family physicians, general internists, or general practitioners) by individuals with schizophrenia differed in antipsychotic medication management and subsequent hospitalization by age, gender, race-ethnicity, insurance, rurality, and region. METHODS: Data for the study were from office visit forms completed between 1999 and 2007 by physicians in the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. A total of 3,359 outpatient visits by individuals with a diagnosis of schizophrenia were identified. The research team used four logistic regression models to test the relationship of sociodemographic variables to antipsychotic medication management during the visit and to hospitalization after the visit. The four models controlled for available clinical covariates with or without physician specialty in the entire cohort and in the cohort of visits in which patients had no active psychotic symptoms. RESULTS: In at least three of the four models, the research team observed that visits by non-Hispanic black patients had significantly (p<.05) greater odds of involving antipsychotic medication management than visits by non-Hispanic whites (range of odds ratios ORs 1.66 to 1.88) and of resulting in hospitalization (range of ORs, 3.52 to 6.95). In all four models, visits by patients who lacked insurance were significantly less likely to result in hospitalization than visits by patients who had private insurance (OR=<.001 in all models). CONCLUSIONS: These findings provide the first national evidence of potential treatment disparities for schizophrenia. Further research is needed to definitively identify disparities and to understand their causes and consequences.