Medication adherence levels and differential use of mental-health services in the treatment of schizophrenia

Ascher-Svanum, Haya; Zhu, Baojin; Faries, Douglas E.; Furiak, Nicolas M; Montgomery, William

doi:10.1186/1756-0500-2-6

Cited by 51 publications

(35 citation statements)

References 20 publications

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“…Substance abuse, which considerably undermines optimum disease management due to the negative influence of substance abuse on treatment adherence 25 , was significantly greater amongst recently diagnosed patients than chronic patients during the retrospective year (p50.0001) and during the first prospective year (p50.0001).…”

Section: Patient Demographicsmentioning

confidence: 97%

Burden of schizophrenia in recently diagnosed patients: healthcare utilisation and cost perspective

Nicholl

Akhras

Diels³

et al. 2010

Current Medical Research and Opinion

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Section: Patient Demographicsmentioning

confidence: 97%

Burden of schizophrenia in recently diagnosed patients: healthcare utilisation and cost perspective

Nicholl

Akhras

Diels³

et al. 2010

Current Medical Research and Opinion

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“…In 2005, rehospitalization costs related to antipsychotic nonadherence in the United States (US) ranged from $1.4–$1.8 billion [14]. In one study, nearly 30% of partially or fully nonadherent patients were hospitalized over 1 year compared with 17% of adherent patients [15]. The average length of hospital stay for nonadherent, partially adherent, and adherent patients was 18 days, 30 days, and 9 days, respectively [15].…”

Section: Introductionmentioning

confidence: 99%

Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia

et al. 2013

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BackgroundThe research goal is to better understand prescriber, patient, and caregiver perspectives about long-acting injectable (LAI) antipsychotic therapy and how these perspectives affect LAI use. Addressing these perspectives in the clinic may lead to greater success in achieving therapeutic goals for the patient with schizophrenia.MethodsEthnographic information was collected from a non-random sample of 69 prescriber-patient conversations (60 with community mental health center [CMHC] psychiatrists; 9 with nurse-practitioners) recorded during treatment visits from August 2011 to February 2012, transcribed and analyzed. Discussions were categorized according to 11 predetermined CMHC topics. In-person observations were also conducted at 4 CMHCs, including home visits by researchers (n = 15 patients) prior to the CMHC visit and observations of patients receiving injections and interacting with staff. Telephone in-depth interviews with psychiatrists, patients, and caregivers to gather additional information on LAI discussion, prescription, or use were conducted.ResultsAntipsychotic treatment decisions were made without patient or caregiver input in 40 of 60 (67%) of psychiatrist-patient conversations. Involvement of patients or caregivers in treatment decisions was greater when discussing LAI (15 of 60 [25%]) vs oral antipsychotic treatment (5 of 60 [8%]). LAIs were not discussed by psychiatrists in 11 of 22 (50%) patients taking oral antipsychotics. When offered, more LAI-naïve patients expressed neutral (9 of 19 [47%]) rather than favorable (3 of 19 [16%]) or unfavorable (7 of 19 [37%]) responses. Prescribers were most concerned about potentially damaging the therapeutic relationship and side-effects when discussing LAIs while patient resistance was often related to negative feelings about injections. Psychiatrists had some success in overcoming patient objections to LAIs by addressing and decomposing initial resistance. More than half (11 of 19 [58%]) of LAI-naïve patients agreed to start LAI treatment following office visits. Patient-described benefits of LAIs vs orals included perceived rapid symptom improvement and greater overall efficacy.ConclusionsIn this study, many psychiatrists did not offer LAIs and most patients and caregivers were not involved in antipsychotic treatment decision making. Opportunities to increase active patient engagement, address resistances, guide patient drug-formulation selection, and provide better LAI-relevant information for more individualized approaches to treating the patient with schizophrenia were present.

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“…Although many studies have addressed the clinical consequences of nonadherence in schizophrenia, utilization of health care resources and costs have received little attention. Nonadherence to antipsychotic medication also has a relevant socioeconomic facet, because it is likely to result in an increase in the frequency of relapse, more severe symptoms, and longer hospital stays, which may lead to increased utilization of health care resources18 and costs 19,20. In particular, relapse has been consistently noted to be an important predictor of subsequent relapse and treatment costs 21.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of the economic aspects of nonadherence to antipsychotic medication in patients with schizophrenia

Dilla¹,

Ciudad²,

Álvarez³

2013

PPA

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PurposeThere is strong evidence supporting the link between nonadherence to antipsychotic medication and relapse of schizophrenia. However, less obvious are the economic consequences of nonadherence. The systematic review reported here evaluated the economic aspects of nonadherence to antipsychotic medication.MethodsA systematic review of scientific papers in the PubMed MEDLINE, Embase, PsychINFO, BIOSIS, and Evidence-Based Medicine Reviews databases was undertaken. Studies that measured adherence to antipsychotic medication and that provided comparative information on health care costs were included.ResultsEight studies met the inclusion criteria. All were observational. Despite the differences between the studies in terms of design, adherence measures, and cost components analyzed, the results of this systematic review indicate that nonadherence to antipsychotic medication is associated with increased hospitalization rates and resource utilization, resulting in increased direct health care costs.ConclusionNonadherence to antipsychotic medication results in poor health and economic outcomes; therefore, the authors suggest endorsing interventions aimed at improving adherence because they can improve patient health without substantially increasing costs.

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Medication adherence levels and differential use of mental-health services in the treatment of schizophrenia

Cited by 51 publications

References 20 publications

Burden of schizophrenia in recently diagnosed patients: healthcare utilisation and cost perspective

Burden of schizophrenia in recently diagnosed patients: healthcare utilisation and cost perspective

Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia

Systematic review of the economic aspects of nonadherence to antipsychotic medication in patients with schizophrenia

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