RACE, QUALITY OF CARE AND ANTIPSYCHOTIC PRESCRIBING PRACTICES IN PSYCHIATRIC EMERGENCY SERVICES

Objective: The study examined whether the prescription practices of cl inicians in psychiatric emergency services differed for African-Americ an patients. Prescription of antipsychotic medications and its relatio n to quality of care was a particular focus. Methods: Data from 442 in dependently observed evaluations of patients in psychiatric emergency services were examined using multivariate analyses. The observations w ere made during a five-year period at four urban general hospitals in California. Results: Clinicians in the four emergency services, most o f whom were Caucasian, prescribed more psychiatric medications to Afri can Americans than to other patients and devoted significantly less ti me to their evaluations. African Americans received more oral doses an d more injections of antipsychotic medications, and the mean 24-hour d osage of antipsychotics (1,321 milligrams) was significantly higher th an for other patients (825 milligrams). The tendency to overmedicate A frican-American patients was lower when clinicians' efforts to engage the patients in treatment were rated higher. Conclusions: The results highlight the importance of efforts to engage African Americans in the treatment process and the need for clinical skills and training to he lp bridge cultural distances.