Influence of medication treatment patterns on resource use for patients hospitalized for schizophrenia

Abstract

The influence of medication treatment patterns on resource use for patients hospitalized for schizophrenia was studied. Patients hospitalized with a primary diagnosis of schizophrenia or schizo-affective disorder discharged between October 1, 2003, and September 30, 2004, were identified from a large, multihospital database. The duration of dosage adjustment was defined as the period between first and last days of dosage change. Ordinary least-squares regression was used to examine the relationships between labeled dosage-escalation durations, actual durations of dosage adjustment, and length of stay. The study sample consisted of 21,950 hospitalized schizophrenia patients, representing 30,873 hospitalizations from 157 hospitals. The majority of patients were 18-44 years old (56.3%), covered by Medicare (46.6%), and admitted through the emergency room (55.5%). The average length of hospital stay was 10 days, and 30% of patients were readmitted for a related reason within 90 days. The labeled dosage-escalation duration was not correlated with the actual duration of dosage adjustment (r = 0.05, p < 0.0001) or with longer hospital stays (r = -0.03, p < 0.0001). Drug-related factors affecting length of stay included medication changes (p < 0.0001), dose changes (p < 0.0001), use of short-acting intramuscular antipsychotics ( p < 0.0001), and medications to manage extrapyramidal symptoms (p < 0.0001). Analysis of information about patients hospitalized for schizophrenia revealed that antipsychotic medication changes, prolonged dosage escalation, and initial use of short-acting intramuscular antipsychotics were significantly associated with a greater than average length of stay. Longer labeled dosage-escalation durations were not associated with longer hospital stays.