VA Health Care:

Implementation of Prescribing Guideline for Atypical Antipsychotic Drugs Generally Sound

GAO-02-579: Published: Apr 29, 2002. Publicly Released: Apr 29, 2002.

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Cynthia A. Bascetta
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The Department of Veterans Affairs (VA) provides health care services to veterans who have been diagnosed with psychosis--primarily schizophrenia, a disorder that can substantially limit their ability to care for themselves, secure employment, and maintain relationships. These veterans also have a high risk of premature death, including suicide. Effective treatment, especially antipsychotic drug therapy, has reduced the severity of their illnesses and increased their ability to function in society. VA's guideline for prescribing atypical antipsychotic drugs is sound and consistent with published clinical practice guidelines used by public and private health care systems. VA's prescribing guideline, recommends that physicians use their best clinical judgment, based on clinical circumstances and patients' needs, when choosing among the atypical drugs. Most Veterans Integrated Service Networks and facilities use VA's prescribing guideline; however, five VISNs have additional policies and procedures for prescribing atypical antipsychotic drugs. Although these procedures help manage pharmaceutical cost, they also have the potential to result in more weight given to cost than clinical judgment which is not consistent with the prescribing guideline.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: GAO recommended that the Secretary of Veterans Affairs (VA) monitor Veterans Integrated Service Networks' (VISN) and medical facilities' implementation of VA's atypical antipsychotic drug prescribing guideline. Shorty after the report was issued, the Assistant Deputy Under Secretary for Health discussed the guideline with VISN directors and reiterated that all employees should recognize it as VA policy that should be strictly followed. In addition, the VA's Chief Consultant for Pharmacy Benefits Management on August 2, 2002, told VISN pharmacy managers that the guideline should be adhered to. Further, VA improved the capability of its pharmacy database (Proclarity) so that VA management is now monitoring physician prescribing practices at each facility.

    Recommendation: To ensure that the atypical antipsychotic prescribing guideline is implemented consistent with VA intent, the Secretary of Veterans Affairs should direct the Under Secretary for Health to monitor implementation of the guideline by Veterans Integrated Service Networks and facilities. In doing so, the Secretary should ensure that facility policies and procedures conform to the intent of the guideline and allow physicians to prescribe the most appropriate atypical antipsychotic drugs for their patients.

    Agency Affected: Department of Veterans Affairs


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