Pharmacy Data Identify Poorly Adherent Patients With Schizophrenia at Increased Risk for Admission

Valenstein, Marcia; Copeland, Laurel A.; Blow, Frederic C.; McCarthy, John F.; Zeber, John E.; Gillon, Leah; Bingham, C. Raymond; Stavenger, Thomas

doi:10.1097/00005650-200208000-00002

Cited by 309 publications

(262 citation statements)

References 31 publications

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“…The lower adherence to antipsychotic treatment associated with a greater frequency and longer duration of schizophrenia-related hospitalizations was consistent with prior research that examined adherence over shorter periods of time (Gilmer et al 2004;Valenstein et al 2002;Weiden et al 2004). Also, the significant association between the degree of adherence and the likelihood of psychiatric hospitalization corroborates previously reported research involving partial antipsychotic adherence.…”

Section: Discussionsupporting

confidence: 88%

“…This is important because antipsychotic adherence is correlated with psychiatric hospitalization. Over a one year period, individuals with schizophrenia who consumed less than 80% of their medication (i.e., poor adherers) had a 2.4 greater likelihood of a psychiatric admission relative to those who consumed 80% or more (i.e., good adherers) (Valenstein et al 2002). Others have reported a similar association between poor antipsychotic adherence and increased hospitalization rates (Gilmer et al 2004;Weiden et al 2004).…”

Section: Introductionmentioning

confidence: 97%

“…In this study non-Whites were more likely to be classified in light or moderate use whereas Whites were primarily classified as continuous use. Others have similarly reported racial differences in antipsychotic adherence (Gilmer et al 2004;Valenstein et al 2004;Valenstein et al 2002). Models such as assertive community treatment (ACT) have successfully reduced hospitalizations in general, including among ethnic minorities who had language and cultural barriers (Yang et al 2005), but its effect on antipsychotic compliance awaits further study.…”

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confidence: 99%

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Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia

dosReis

Johnson

Steinwachs

et al. 2008

Schizophrenia Research

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Objective(s)-To characterize the longitudinal patterns of antipsychotic treatment and to investigate the relationship between antipsychotic treatment patterns and acute hospitalizations among adults with schizophrenia. We hypothesized that continuous antipsychotic treatment would be associated with fewer hospitalizations and shorter lengths of stay.Method-Seven years of retrospective Maryland Medicaid administrative data were used to examine inpatient medical encounters and outpatient psychotropic treatment in community-based settings from 1993 through 2000. The sample consisted of 1,727 adults continuously enrolled in the Maryland Medicaid program from July 1992 through June 1994, and diagnosed with schizophrenia. The main outcome measures were a) any schizophrenia hospitalization; b) number of schizophrenia hospitalizations; and c) inpatient days associated with a primary diagnosis of schizophrenia.Results-The average duration of antipsychotic use was six months in any single year and four and one-half years across the entire study period. Compared to individuals with a more continuous pattern of antipsychotic treatment, individuals with moderate or light use had odds of hospitalization for schizophrenia that were 52 or 72 percent greater (95%CI: 30−75% greater, 49−100% greater respectively). Light users of antipsychotics have an average length of stay per hospitalization that is approximately 20 percent longer than the average for continuous users (95%CI: 2−39% longer). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (Lehman et al. 2004;Lehman et al. 1998). This results in fewer symptoms, a less episodic course (APA 1997), better clinical and functional outcomes for adults with schizophrenia (Lehman et al. 1995;Verdoux et al. 2000), and fewer relapses (Herz et al. 1991;Schooler 2006). Conclusions-Findings NIH Public AccessDespite this evidence, research on outpatient utilization spanning 1987−1997 shows that it rarely is continuous in a given year (dosReis et al. 2002;McCombs et al. 1999;Menzin et al. 2003;Mojtabai et al. 2002;Vanelli et al. 2001;Velligan et al. 2003;Williams et al. 1999).Only 12−30% of individuals received continuous antipsychotic treatment over a one year period (McCombs et al. 1999;Williams et al. 1999). From 17−24% of adults with schizophrenia do not receive medication in outpatient settings (dosReis et al. 2002;McCombs et al. 1999). Prescription refills over a nine-month period in 1998−1999 indicate that approximately 30% of individuals discontinue antipsychotic medication within three months after initiating treatment (Vanelli et al. 200...

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 97%

mentioning

confidence: 99%

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Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia

dosReis

Johnson

Steinwachs

et al. 2008

Schizophrenia Research

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“…Studies consistently showed that nonadherence was significantly associated with poorer outcomes, including greater risk of hospitalization [Ahn et al 2008;Eaddy et al 2005;Gilmer et al 2004;Law et al 2008;Morken et al 2008;Svarstad et al 2001;Valenstein et al 2002;Weiden et al 2004a], greater use of emergency services , longer length of hospital stay Valenstein et al 2002] and greater risk of suicide [Leucht and Heres, 2006;Llorca, 2008]. The consequences to society included having to deal with the consequences of violence , substance abuse and criminal behaviour .…”

Section: Discussionmentioning

confidence: 99%

Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review

Higashi¹,

Medic

Littlewood

et al. 2013

Therapeutic Advances in Psychopharmacology

472

381

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Background: Nonadherence to medication is a recognized problem and may be the most challenging aspect of treatment. Methods:We performed a systematic review of factors that influence adherence and the consequences of nonadherence to the patient, healthcare system and society, in patients with schizophrenia. Particular attention was given to the effect of nonadherence on hospitalization rates, as a key driver of increased costs of care. A qualitative systematic literature review was conducted using a broad search strategy using disease and adherence terms. Due to the large number of abstracts identified, article selection was based on studies with larger sample sizes published after 2001. Thirty-seven full papers were included: 15 studies on drivers and 22 on consequences, of which 12 assessed the link between nonadherence and hospitalization. Results: Key drivers of nonadherence included lack of insight, medication beliefs and substance abuse. Key consequences of nonadherence included greater risk of relapse, hospitalization and suicide. Factors positively related to adherence were a good therapeutic relationship with physician and perception of benefits of medication. The most frequently reported driver and consequence were lack of insight and greater risk of hospitalization respectively. Conclusions: Improving adherence in schizophrenia may have a considerable positive impact on patients and society. This can be achieved by focusing on the identified multitude of factors driving nonadherence.

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“…MPR is the ratio of the amount of medication the patient received (prescriptions filled) to the amount of medication needed to receive in order to take the medication continuously as prescribed. MPR close to 1.0 (80-110%) is considered to define good adherence (8).…”

Section: Terminology and Definitionsmentioning

confidence: 99%

Adherence and Long-Acting Injectable Antipsychotics in Schizophrenia: An Update

Mohr¹,

Volavka²

2012

Dusunen Adam

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Pharmacy Data Identify Poorly Adherent Patients With Schizophrenia at Increased Risk for Admission

Abstract: Many health care systems may be able to use pharmacy data to identify poorly adherent patients with schizophrenia. These patients are at-risk for admission and may benefit from intervention.

Cited by 309 publications

References 31 publications

Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia

Antipsychotic treatment patterns and hospitalizations among adults with schizophrenia

Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review

Adherence and Long-Acting Injectable Antipsychotics in Schizophrenia: An Update

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