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SHORT REPORTS:
Anne Connolly and David Taylor
Ethnicity and quality of antipsychotic prescribing among in-patients in south London
The British Journal of Psychiatry 2008; 193: 161-162 [Abstract] [Full text] [PDF]
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[Read eLetter] Quality or quantity of antipsychotic prescribing?
Edwin Lee   (21 August 2008)

Quality or quantity of antipsychotic prescribing? 21 August 2008
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Edwin Lee,
Assistant Professor
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China

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Re: Quality or quantity of antipsychotic prescribing?

elee{at}cuhk.edu.hk Edwin Lee

Connolly et al deserve praise for their contribution in research of association between ethnicity and antipsychotic prescription. They reported similar prescribing quality for Black and White in-patients in South London after controlling for 23 potential confounding factors.1 Their paper may be helpful in prevention of institutional racism which may be an increasing concern in mental health services.

On the other hand, I am concerned about the authors' use of "quality" to describe antipsychotic prescription pattern. The four outcomes compared in the paper appear to be measurement of quantitative rather than qualitative difference of antipsychotic prescription. It may be more reasonable to conclude that the prescribing pattern did not differ substantially between Black and White patients.

As recognized by the authors, treatment decision in mental disorders is influenced by patientsˇ¦, doctorsˇ¦ and environmental factors.2 Determination of quality of prescription, like better or worse, in terms of prescription pattern may be more valid if thereˇ¦s a shared standard as reference. Nevertheless, studies of mental disorders3,4 showed heterogeneity of patientsˇ¦ treatment response and whether such a reference really stands is opened to question.

There are other options for investigation about influence of ethnicity on treatment decisions. Survey or qualitative research of treatment decision among patients and doctors may help us to understand the behaviour and reasons behind. The doctor-patient relationship5 especially communication may be one of the important factor. It will be interesting for the authors to have further study especially in the markedly different centre.

1 Connolly A, Taylor D. Ethnicity and quality of antipsychotic prescribing among in-patients in south London. Br J Psychiatry 2008; 193: 161-2.

2 Balsa AI, McGuire TG. Prejudice, clinical uncertainty and stereotyping as sources of health disparities. J Health Econ 2003; 22: 89- 116.

3 Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK; Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005; 353: 1209-23.

4 Perlis RH, Ostacher MJ, Patel JK, Marangell LB, Zhang H, Wisniewski SR, Ketter TA, Miklowitz DJ, Otto MW, Gyulai L, Reilly-Harrington NA, Nierenberg AA, Sachs GS, Thase ME. Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry 2006; 163: 217-24.

5 Street RL Jr, Gordon H, Haidet P. Physicians' communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor? Soc Sci Med 2007; 65: 586-98.