Understanding Prescription Decisions in Schizophrenia

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DESCRIPTION (provided by candidate): This revised application outlines an integrated training and research program for a NIMH K01 Mentored Research Scientist Development Award. My long-term career goal is to develop a program of research focused on medication effectiveness in individuals with serious mental illnesses (SMI) that includes investigating the process and outcomes of medication prescription in typical clinical practice settings, and applying this knowledge to the design of interventions to improve medication prescription decisions. My immediate career goal is to understand the prescription of complex, multi-drug regimens ('polypharmacy') in schizophrenia, focusing specifically on combination antipsychotic regimens in this application. Both clinician-related ('supply-side') and patient and family-related ('demand-side') factors, which are equally important and influential forces affecting medication management decisions will be considered. To achieve these goals, I will complete didactic coursework and mentored training activities concurrently with research projects that focus on prescription decision-making, anti-psychotic polypharmacy, and survey methods, as well as the development of interventions to improve prescription decisions in schizophrenia. These activities will be conducted under the guidance of several faculty members from across the country with expertise in mental health services research, psychopharmacology, and both cognitive and clinical psychology. A research plan of four projects is proposed. The first study will use Veterans Administration administrative encounter data to examine the prevalence and correlates of prescription of multiple antipsychotic medications in schizophrenia. This data will permit the evaluation of prescribing patterns across a range of inpatient and outpatient facilities covering a vast geographic area. The second and third studies will be conducted in conjunction with two funded NIMH R01 grants. One project will evaluate the modifiable clinician characteristics/behaviors that influence prescription decisions regarding combined antipsychotic regimens in a nation-wide sample of psychiatrists. The new third research project will examine the willingness of psychiatrists to adopt evidence-based treatments for schizophrenia and their preferences for various formats for educational interventions. The fourth study expands the evaluation of prescription decision-making in schizophrenia by focusing on the roles of both the patient and the family in this process. Understanding the patient, clinician, and treatment setting factors that are correlated with antipsychotic polypharmacy, while also uncovering aspects of the cognitive processes involved in prescription decision-making that may be modifiable, will inform the subsequent development of an R01 application aimed at improving the process of prescription decision-making for persons with schizophrenia.