Adherence and outcomes associated with copayment burden in schizophrenia: a cross-sectional survey

Kim, Edward; Gupta, Shaloo; Bolge, S.; Chen, Chi‐Chang; Whitehead, Richard; Bates, John A.

doi:10.3111/13696991003723023

Cited by 28 publications

(33 citation statements)

References 26 publications

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“…Patient access to health care services (affected by geographic location, transportation difficulties, and cultural or language issues) may influence patient adherence to antipsychotic therapy 8. Patients with schizophrenia are frequently unemployed and/or in poverty,30,31 which may contribute to nonadherence caused by the financial burden of medication (eg, medication copayments) 30,32. Even small increases in insurance copayments have been associated with declining adherence and corresponding increases in psychiatric hospital admissions 32.…”

Section: Resultsmentioning

confidence: 99%

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

Shuler¹

2014

PPA

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PurposeIn patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams.Materials and methodsA systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia.ResultsOf 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports corresponding reductions in relapse rates, inpatient admissions, and associated costs.ConclusionOptimization of medication and involvement of caregivers are important to promoting adherence. A multidisciplinary team approach may be invaluable in identifying barriers to adherence and helping schizophrenia patients overcome them.

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Section: Resultsmentioning

confidence: 99%

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

Shuler¹

2014

PPA

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“…This original survey, conducted between December 2007 and February 2008, was initiated to understand the treatments, attitudes, health behaviors, and health outcomes among patients with schizophrenia. The data generated from this survey has been used in several previous studies, each of which has outlined the methods in some detail [4,19]. Briefly, patients were convenience sampled in one of two ways to participate in a self-administered survey to create the dataset: (1) patients who reported having schizophrenia in an Internet-based consumer panel (Lightspeed Research Ailment Panel) were randomly sent an invitation to participate in a web-based questionnaire via email, and (2) patients were also recruited from grassroots campaigns and newspaper advertising to arrive at a central interview facility to take a paper copy of the survey instrument.…”

Section: Methodsmentioning

confidence: 99%

“…For this study we used a threshold of one or more items to identify nonadherence; adherence was classified as reporting "no" for all items. This approach has been reported in previous schizophrenia research [19]. …”

Section: Methodsmentioning

confidence: 99%

A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia

DiBonaventura

Gabriel²,

Dupclay³

et al. 2012

BMC Psychiatry

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258

168

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BackgroundAntipsychotic medications often have a variety of side effects, however, it is not well understood how the presence of specific side effects correlate with adherence in a real-world setting. The aim of the current study was to examine the relationship between these variables among community-dwelling patients with schizophrenia.MethodsData were analyzed from a 2007-2008 nationwide survey of adults who self-reported a diagnosis of schizophrenia and were currently using an antipsychotic medication (N = 876). The presence of side effects was defined as those in which the patient reported they were at least "somewhat bothered". Adherence was defined as a score of zero on the Morisky Medication Adherence Scale. To assess the relationship between side effects and adherence, individual logistic regression models were fitted for each side effect controlling for patient characteristics. A single logistic regression model assessed the relationship between side effect clusters and adherence. The relationships between adherence and health resource use were also examined.ResultsA majority of patients reported experiencing at least one side effect due to their medication (86.19%). Only 42.5% reported complete adherence. Most side effects were associated with a significantly reduced likelihood of adherence. When grouped as side effect clusters in a single model, extra pyramidal symptoms (EPS)/agitation (odds ratio (OR) = 0.57, p = 0.0007), sedation/cognition (OR = 0.70, p = 0.033), prolactin/endocrine (OR = 0.69, p = 0.0342), and metabolic side effects (OR = 0.64, p = 0.0079) were all significantly related with lower rates of adherence. Those who reported complete adherence to their medication were significantly less likely to report a hospitalization for a mental health reason (OR = 0.51, p = 0.0006), a hospitalization for a non-mental health reason (OR = 0.43, p = 0.0002), and an emergency room (ER) visit for a mental health reason (OR = 0.60, p = 0.008).ConclusionsAmong patients with schizophrenia, medication side effects are highly prevalent and significantly associated with medication nonadherence. Nonadherence is significantly associated with increased healthcare resource use. Prevention, identification, and effective management of medication-induced side effects are important to maximize adherence and reduce health resource use in schizophrenia.

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“…A study in the USA found that higher patient cost-sharing (eg, copayments or coinsurance) was associated with a lower likelihood of adherence with antipsychotic medication and a shorter time to discontinuation of medication 58. In another study, schizophrenia patients who perceived copayment burden were less than half as likely to have complete adherence 59. This result needs to be considered in light of the study’s methodological weaknesses that included a cross-sectional design and use of self-reported patient data.…”

Section: Factors Associated With Nonadherencementioning

confidence: 97%

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

Haddad¹,

Brain²,

Scott³

2014

PROM

454

418

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Nonadherence with medication occurs in all chronic medical disorders. It is a particular challenge in schizophrenia due to the illness’s association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment. Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum. It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life. It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence. There is no gold standard approach to the measurement of adherence as all methods have pros and cons. Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives. These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual. Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches. There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker. Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient. These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence.

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Adherence and outcomes associated with copayment burden in schizophrenia: a cross-sectional survey

Cited by 28 publications

References 26 publications

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

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