AACP Newsletter, Volume 12,
Number 4, Autumn 1998
Regional Reports:
Ohio
As a new and obviously loosely structured group, we struggled to find a way to start actually working. The AACP provided a model through its listserv. With OPA support, we established an e-mail subscription list and took on as a first task the establishment of a position on the issue of access to novel antipsychotic medications. It was an issue we all viewed as critical and one on which we could easily agree. After reaching a consensus on our position statement, we shared it in a letter to all the county board executive directors, the state departments of mental health and corrections and the state AMI. After establishing this independent position, we asked the OPA to endorse the position. At its summer Council meeting, it did officially support the position. This may well be a first, a district branch of the APA endorsing what can be viewed as a standard of care position established by a group of community psychiatrists.
Drawing from a number of sources, the Coalition drew the following conclusions:
- There is increasing evidence that the long-term outcome of schizophrenia is best when effective, continuous treatment is provided early in a person's illness.
- Standard antipsychotic medications have many more uncomfortable side effects than the newer antipsychotic medications, contributing to the problem of patient non-adherence to prescribed medication. Also, these older medications carry a substantially greater risk of the potentially irreversible movement abnormality - tardive dyskinesia.
- While the cost of the newer medication is substantially higher than that of the older medications, pharmacoeconomic studies in other areas (e.g., reduced relapse and hospitalization) result in no significant change in the total cost of care.
- Based on available evidence, the new antipsychotic drugs (risperidone and olanzapine; possibly quetiapine as well) are superior in terms of safety and effectiveness to older agents and should be considered first-line treatments for schizophrenia and related psychotic disorders. The Texas Department of Mental Health/Mental Retardation had already revised its treatment algorithm to reflect this position. There are beginning to be concerned about the liability entailed in withholding these agents from appropriate patients.
Given the current state of knowledge, it is our opinion that the new generation of antipsychotic medications (except clozapine) needs to be made available as first-line treatments for appropriate individuals throughout our systems of care. Similarly, clozapine needs to be available for individuals with treatment-refractory psychotic disorders. Access to these medications needs to be not only in Ohio's public psychiatric hospitals and community mental health agencies but also in its jails, prisons and youth service facilities. Access to psychiatrists in each of these settings is also clearly critical.
Access to these medications is currently possible for Medicaid recipients through its open formulary. These formulary practices need to continue as Medicaid moves further into managed care. For individuals not Medicaid eligible, we believe that state and county government and the pharmaceutical industry must take responsibility for equitable access to these important new medications.
Clearly this is only a small step forward in establishing a statewide community psychiatry organization. We hope this and future activities of this group will have a meaningful impact on the Ohio system. We think our model is promising and are very grateful to the support we have received from our APA District Branch. We are curious if other states have had any similar success with statewide mobilization for community psychiatrists.
Continue to the Iowa Regional ReportContinue to the Texas Regional Report
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