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Racial and Ethnic Differences in Psychiatry Resident Prescribing: a Quality Improvement Education Intervention to Address Health Equity

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Abstract

Objective

Quality improvement (QI) tools can identify and address health disparities. This paper describes the use of resident prescriber profiles in a novel QI curriculum to identify racial and ethnic differences in antidepressant and antipsychotic prescribing.

Methods

The authors extracted medication orders written by 111 psychiatry residents over an 18-month period from an electronic medical record and reformatted these into 6133 unique patient encounters. Binomial logistic models adjusted for covariates assessed racial and ethnic differences in antipsychotic or antidepressant prescribing in both emergency and inpatient psychiatric encounters. A multinomial model adjusted for covariates then assessed racial and ethnic differences in primary diagnosis. Models also examined interactions between gender and race/ethnicity.

Results

Black (adjusted OR 0.66; 95% CI, 0.50–0.87; p < 0.01) and Latinx (adjusted OR, 0.65; 95% CI, 0.49–0.86; p < 0.01) patients had lower odds of receiving antidepressants relative to White patients despite diagnosis. Black and Latinx patients were no more likely to receive antipsychotics than White patients when adjusted for diagnosis. Black (adjusted OR 3.85; 95% CI, 2.9–5.2) and Latinx (adjusted OR 1.60; 95% CI, 1.1–2.3) patients were more likely to receive a psychosis than a depression diagnosis when compared to White patients. Gender interactions with race/ethnicity did not significantly change results.

Conclusions

Our findings suggest that racial/ethnic differences in antidepressant prescription likely result from alternatively higher diagnosis of psychotic disorders and prescription of antipsychotics in Black and Latinx patients. Prescriber profiles can serve as a powerful tool to promote resident QI learning around the effects of structural racism on clinical care.

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Funding

Dr. Wasser’s salary is funded in part by the State of Connecticut, Department of Mental Health and Addiction Services, but this publication does not express the views of the Department of Mental Health and Addiction Services or the State of Connecticut. Ms. Cerdeña is supported by the Robert Wood Johnson Foundation Health Policy Research Scholars program and the National Institutes of Health Medical Scientist Training Program (T32 T32GM136651). The views and opinions expressed are those of the authors.

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Authors and Affiliations

  1. Yale University, New Haven, CT, USA

    Ignacio Cerdeña, Terrell Holloway, Jessica P. Cerdeña, Tobias Wasser, Frank Fortunati, Robert Rohrbaugh & Luming Li

  2. Yale New Haven Hospital, New Haven, CT, USA

    Angelina Wing

Authors
  1. Ignacio Cerdeña
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  2. Terrell Holloway
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  3. Jessica P. Cerdeña
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  4. Angelina Wing
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  5. Tobias Wasser
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  6. Frank Fortunati
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  7. Robert Rohrbaugh
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  8. Luming Li
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Corresponding author

Correspondence to Ignacio Cerdeña.

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Dr. Rohrbaugh is an Academic Psychiatry editorial board member. Manuscripts that are authored by a member of the Editorial Board undergo the same editorial review process applied to all manuscripts, including double-blinded peer review. On behalf of the remaining authors, the corresponding author states that there is no conflict of interest.

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Cerdeña, I., Holloway, T., Cerdeña, J.P. et al. Racial and Ethnic Differences in Psychiatry Resident Prescribing: a Quality Improvement Education Intervention to Address Health Equity. Acad Psychiatry 45, 13–22 (2021). https://doi.org/10.1007/s40596-021-01397-z

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