AHRQ - "Comparative Effectiveness Research Diffusion and Mental Health Care Disparities"

Comparative Effectiveness Research (CER) compares benefits and risks of different treatments. However, little is known about the impact of large-scale CER implementation as conceived in the 2010 Affordable Care Act (ACA) on equity in health care across racial/ethnic groups.  Identifying the influence of FDA risk warnings on disparities in psychotropic drug use provides a platform to understand how CER will influence disparities in certain situations. The FDA undertakes comparative effectiveness research (e.g., meta-analyses) to determine risks and to support oversight for certain medications. While preliminary evidence suggests Black and Latino families are less likely to heed drug risk warnings for antidepressants (Depetris and Cook In Press) and olanzapine (Dusetzina, Cook et al. In Press), the impact of the warnings on switching to lower-risk drugs is unclear, there is room to improve statistical methods of identification, and a need to understand the role of providers and HMOs in the effect of warnings on patterns of high-risk drug use.

Our specific aims are to:
1) Track changes in antidepressant use among youth and antipsychotic drug use among youth and adults by racial/ethnic group as they were influenced by FDA risk warnings and advisories.
2) Assess whether specific recommendations of FDA warnings influenced disparity trends in a) treatments recommended by CER-generated evidence (e.g., fluoxetine for depressed youth, metabolic screening for antipsychotic users); and b) psychotropic drug use that is potentially harmful (e.g., olanzapine use).
3) Identify how provider characteristics and HMO membership act as mechanisms that underlie the differential diffusion of CER via health risk warnings.

We choose to study psychotropic drugs because they are widely prescribed (antidepressants were the third most widely prescribed drug class in the U.S. (Hsiao et al. 2010)) and have serious risks (Lasser et al. 2002). Also, the demand for these drugs was strongly impacted by changes in government warnings (Fullerton et al. 2010). We propose to generate evidence of how FDA risk warnings alter high-risk drug use for racial/ethnic groups. If we find racial/ethnic disparities in diffusion of risk warnings and advisories, this suggests policymakers should focus on improving uptake of CER among minorities.

Funding Acknowledgement

This study is supported by Research Grant R01HS021486, funded by the Agency for Healthcare Research and Quality (AHRQ).