Characteristics Associated with Facility Clozapine Utilization by Patients Diagnosed with Schizophrenia Restricted; Files Only
Iacobelli, Luca (Spring 2024)
Published
Abstract
Research has shown that clozapine has been underutilized in the US. Barriers to its use have been thought to be occurring at both an individual and systemic level, with many studies suggesting the former is potentially due to organizational factors. Past literature has stated that facilities lacking robust and structural support are likely making it harder for facilities to use clozapine to begin with. The goal of our study is to examine if what was found in past literature using physician surveys is consistent with a large, nation-wide data set. Additionally, we included demographic factors to lessen mediating and moderating influences as well as to see if racial disparities in clozapine use were also occurring within facilities. We used publicly available data from SAMHSA to help answer this. More specifically, we used the 2020-NMHS survey and cleaned it so that approximately 2000 facilities were examined. 34 facility characteristics were looked at and were analyzed using a multiple logistic regression. This analysis was enhanced through the use of a chi-square analysis to look at individual correlations and an AUC-ROC curve to measure the overall performance and predictive power of our model. Our results showed that facility characteristics that aided in making psychiatric treatment more comprehensive increased the likelihood of clozapine therapy to be offered. They also showed that demographic factors did not hold as strong of an influence. These results suggest that facility characteristics that are helpful for clozapine management could possibly be more helpful in improving clozapine access, as opposed to increasing the availability of robust supportive services as past literature previously indicated. On the other hand, it seems that if racial disparities are occurring, they are more likely to exist at a more individual and prescriber level as opposed to being created by systemic factors. Future research should examine these characteristics in greater detail and analyze potential disparities in the quality and level of care patients receive
Table of Contents
Introduction……………………………………………………………………………………….1
Treatment Resistant Schizophrenia……………………………………………………….3
The History of Clozapine…………………………………………………………………7
Barriers to Clozapine Access……………………………………………………………..9
Hypotheses……………………………………………………………………………….11
Methods………………………………………………………………………………………….13
Data Source………………………………………………………………………………13
Procedures………………………………………………………………………………..14
Variable Selection………………………………………………………………………..14
Data Preparation………………………………………………………………………….17
Data Analysis…………………………………………………………………………….17
Results…………………………………………………………………………………………....20
Multivariate Analysis…………………………………………………………………….20
Univariate Analysis………………………………………………………………………24
AUC-ROC Curve………………………………………………………………………...28
Model Performance………………………………………………………………………29
Discussion………………………………………………………………………………………..30
Limitations of the Present Study…………………………………………………………35
General Conclusion………………………………………………………………………36
References………………………………………………………………………………………..39
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File download under embargo until 24 May 2026 | 2024-04-23 17:54:17 -0400 | File download under embargo until 24 May 2026 |