Racial disparities with PRN medication usage in inpatient psychiatric treatment

Area of Science:

• Psychiatry and Public Health
• Health Services Research
• Health Equity

Background:

• Racial disparities in psychiatric care contribute to significant public health inequities.
• Understanding disparities in medication administration is crucial for improving patient outcomes.
• As-needed (pro re nata or PRN) medications are frequently used in inpatient psychiatric settings.

Purpose of the Study:

• To examine racial disparities in the administration of PRN medications in an inpatient psychiatric setting.
• To compare the utilization of PRN antipsychotics versus non-antipsychotics between Black and White patients.
• To identify specific PRN medication classes where racial differences in administration are most pronounced.

Main Methods:

• Analysis of 14,616 inpatient psychiatric encounters from 2019-2020.
• Focus on PRN medication administrations for Black and White patients.
• Logistic regression to assess the association between race and PRN medication use, controlling for demographic and clinical factors.

Main Results:

• Black patients received a higher percentage of PRN medications overall (71.0%) compared to White patients (67.7%).
• Black patients were significantly more likely to receive PRN antipsychotics (17.7%) than White patients (8.2%).
• Black patients showed increased likelihood of receiving PRN antipsychotics (OR 1.58), hydroxyzine (OR 2.09), and lorazepam (OR 1.32) compared to White patients, after controlling for covariates.

Conclusions:

• Significant racial disparities exist in PRN medication utilization within inpatient psychiatric care.
• Black patients are disproportionately prescribed PRN antipsychotics, hydroxyzine, and lorazepam compared to White patients.
• Further investigation into patient-centered data is warranted to understand and address these medication disparities.