Abstract
BackgroundPersons with schizophrenia frequently discontinue or avoid medications. Under a national community-based mental health program many places in China have started to provide free medications to people with severe mental health disorders in their communities. In the free medication program (FMP) in Liuyang, China, peripatetic psychiatrists prescribed and dispensed antipsychotic medications free of charge at regular intervals and places convenient for all patients through the primary health care system since 2006. Our study aims to test whether adherence to this FMP improves the functioning of people with schizophrenia.MethodsThe research was conducted in Liuyang, a rural county in central China. Data were obtained from three sources: an ad-hoc survey and the program’s management system in 2013 and in-home interviews in 2014 in Liuyang. We conducted a cross-sectional propensity-score based analysis of the “dose” effect of FMP participation on their level of functioning, using medication refill adherence as a proxy for the participatory intensity in the program.ResultsOnly 50.9% of 2,332 participants came for all refills in 2012. Higher refill adherence was associated with slightly worse functional outcomes. The main reasons for refill non-adherence were “unwilling to take medication or only took medication when unwell” (23.6%), “forgot or missed the appointment” (20.6%) and “hospitalized” (20.1%).ConclusionsThe FMP program in Liuyang seemed to have successfully removed barriers in cost and access. However, better refill adherence was not associated with better functional outcomes in this study, which might have been the result of reverse causation. To improve the effectiveness of the FMP, patient-centered measures should be considered.
Highlights
With a worldwide prevalence of 1%, schizophrenia challenges families, communities and health systems and exemplifies the complexities posed by complex non-communicable diseases (Mueser & McGurk, 2004)
Association of program participation and functioning The group with higher refill-medication adherence had a small but statistically significant degree of poorer functioning as compared to its less adherent peer group in 2011 (p = 0.015), after using propensity score to control for a range of potential confounders including socioeconomic and demographic variables, severity of disease and family support and engagement in care, the functioning score in the adherent group is 8.6 (p < 0.001) and in the non-adherent group it is 7.7 (p < 0.001)
The reason for missing medication refills Only 50.9% of the free medication program (FMP) participants came for each of the six free medication refills and 8.9% of participants did not present at any refills in 2011 (Table 2)
Summary
With a worldwide prevalence of 1%, schizophrenia challenges families, communities and health systems and exemplifies the complexities posed by complex non-communicable diseases (Mueser & McGurk, 2004). In China, the implementation of “the National Continuing Management and Intervention Program for Psychoses” ( known as the “686 Program”) provided an opportunity to revisit the question of whether improving access would result in increased compliance and outcome. It began in 2004 and later evolved into the national essential public health service (Song et al, 2011) Under this policy, many sites in China have started to provide free medications to people with severe mental health disorders in their communities, often as the result of the additional local investment into the program. To improve the effectiveness of the FMP, patient-centered measures should be considered
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