Abstract
BackgroundAdherence to antipsychotics for schizophrenia is associated with favorable clinical outcomes. This study compared annual mental-health service utilization by recent medication adherence levels for patients treated for schizophrenia, and assessed whether adherence levels change from pre- to post-psychiatric hospitalization.MethodsWe analyzed data from a large prospective, non-interventional study of patients treated for schizophrenia in the United States, conducted between 7/1997 and 9/2003. Detailed mental-health resource utilization was systematically abstracted from medical records and augmented with patients' self report. Medication possession ratio (MPR) with any antipsychotic in the 6 months prior to enrollment was used to categorize patients as: adherent (MPR ≥ 80%, N = 1758), partially adherent (MPR ≥ 60% < 80%, N = 36), or non-adherent (MPR < 60%, N = 216). Group comparisons employed propensity score-adjusted bootstrap re-sampling methods with 1000 iterations, adjusting for baseline patient demographic and clinical characteristics identified a priori.ResultsAdherent patients had a lower rate of psychiatric hospitalization compared with partially adherent and non-adherent patients (p < 0.001) and were more likely than non-adherent to engage in group therapy, individual therapy, and medication management. Most patients (92.0%) who were adherent in the 6 months prior to hospital admission continued to be adherent 6 months following hospitalization. However, 75.0% of previously partially adherent became adherent, and 38.7% of previously non-adherent became adherent following hospitalization.ConclusionAdherence is associated with lower utilization of acute care services and greater engagement in outpatient mental-health treatment. Adherence is a potentially dynamic phenomenon, which may improve, at least temporarily, following patients' psychiatric hospitalizations.
Highlights
Adherence to antipsychotics for schizophrenia is associated with favorable clinical outcomes
Adherence with antipsychotic medications is critical for reducing the risk of relapse and enhancing long-term functional outcomes [1], non-adherence is typically found in about 40%–50% of patients with schizophrenia [2]
While the link between non-adherence and psychiatric hospitalization is well documented, little is known about the relationships between adherence and utilization of other mental-health resources in the management of schizophrenia, such as emergency services, partial hospitalization, and various outpatient services
Summary
Adherence to antipsychotics for schizophrenia is associated with favorable clinical outcomes. Adherence with antipsychotic medications is critical for reducing the risk of relapse and enhancing long-term functional outcomes [1], non-adherence is typically found in about 40%–50% of patients with schizophrenia [2]. Non-adherence is associated with increased risk of relapse and hospitalization [3,4,5,6,7], the most expensive health service component in the treatment of schizophrenia [8]. While the link between non-adherence and psychiatric hospitalization is well documented, little is known about the relationships between adherence and utilization of other mental-health resources in the management of schizophrenia, such as emergency services, partial hospitalization, and various outpatient services. Lack of expected outpatient resource utilization may signal that a patient is not engaged in the treatment plan and may be nonadherent with medication and at increased risk of relapse and hospitalization
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