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Regional variation in antipsychotic polypharmacy for schizophrenia

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Question: Are there regional differences in the attitudes of nurses and physicians to antipsychotic polypharmacy (APP) and the use of clinical guidelines?

Population: The prevalence of APP in 2004 in different municipalities in Denmark was determined using records from the Danish National Board of Health and the Danish Medicines Agency. The number of outpatients with an ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) diagnosis of schizophrenia spectrum disorder who were treated with more than one antipsychotic (as defined by the filling of prescriptions for more than one antipsychotic within 30 days during 2004) were compared with the total number of antipsychotic-treated patients with schizophrenia spectrum disorder to determine the APP fraction. Two municipalities with a mean APP fraction above the national average of 48.5% and two with a mean APP below this average were selected. The regions had comparable need for mental health services (as determined by socioeconomic predictors) and similar organisation of psychiatric services. The nurses and physicians in one of the main psychiatric departments and outpatient clinics in each region served as the target population.

Setting: Four municipalities in Denmark selected from all 98 municipalities; two with lower APP prescribing than the …

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