The Relationship of Antipsychotic Medication Class and Adherence with Treatment Outcomes and Costs for Florida Medicaid Beneficiaries with Schizophrenia

Becker, Mary; Young, M. Scott; Ochshorn, Ezra; Diamond, Ronald J.

doi:10.1007/s10488-006-0108-5

Cited by 32 publications

(31 citation statements)

References 44 publications

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“…Patients assigned to clozapine were 63% less likely to discontinue than those on LAIR (Hazard Ratio (HR) = .37), while those on olanzapine, risperidone or quetiapine were 17-22% less likely to discontinue (HR = .78-.83) than those on LAIR. [17], to be identified as African American [9,18,19], to be dually diagnosed with alcohol or drug abuse, and to be more severely ill as indicated by a greater likelihood of inpatient psychiatric hospitalization in the previous year and a greater number of outpatient mental health visits [9]. Tellingly, these are all characteristics commonly associated with poor medication compliance [20].…”

Section: Resultsmentioning

confidence: 99%

“…It was initially believed that reduced risk of neurological side effects with second generation antipsychotic medications (SGAs)--currently including clozapine, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole--would enhance tolerability, increase adherence and thereby improve outcomes [9]. Although some subsequent studies of oral medication have not confirmed these findings [10][11][12][13], the introduction of long-acting injectable risperidone (LAIR) (Risperdal Consta Ò ), in 2003, renewed hope that the combination of long-acting formulation with a second generation antipsychotic might offer distinct advantages in the treatment of schizophrenia [4,14,15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Duration of Pharmacotherapy with Long-Acting Injectable Risperidone in the Treatment of Schizophrenia

Mohamed

Rosenheck²,

Harpaz‐Rotem³

et al. 2009

Psychiatr Q

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Although long-acting injectable risperidone (LAIR) has been hypothesized to improve medication adherence compared to oral medications, data from real-world practice have yet to be presented on time to treatment discontinuation. Records of all new prescriptions for antipsychotic medication during the first 2 months of FY 2006 for VA patients diagnosed with schizophrenia (N = 11,821) were examined and duration of treatment with LAIR and oral antipsychotics were calculated for the next 2 years. Multivariable logistic regression was used to identify patient characteristics independently associated with receipt of LAIR. Proportional hazards models were used to compare the likelihood of discontinuing each of the medications as compared to LAIR. Altogether, 2.4% of the 11,821 new starts were prescribed LAIR, 44.6% of whom continued therapy for 540-720 days (18-24 months), less than the 77.1% of those on clozapine, 57.9% on oral conventional antipsychotics, 55.0% on olanzapine, and 49.5% on risperidone, but more than the 27.7% on aripiprazole. After adjusting for potentially confounding factors, patients who were initiated on LAIR were more likely to discontinue their medication than those who were initiated on oral first- or second-generation antipsychotics (SGAs) with the exception ziprasidone and aripiprazole. Less than half of patients on LAIR continued treatment for 18 months, a smaller proportion than of those started on most oral first- or second-generation antipsychotics, suggesting that for many patients with schizophrenia improved adherence from this treatment may not be sustained.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Duration of Pharmacotherapy with Long-Acting Injectable Risperidone in the Treatment of Schizophrenia

Mohamed

Rosenheck²,

Harpaz‐Rotem³

et al. 2009

Psychiatr Q

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“…However, many prior reports were significantly limited because they were conducted with predominantly Euro-American populations. Ethnic and racial disparities in adherence have been noted, with prior studies finding that non-white patients were more likely to have lower adherence (3, 21–23). …”

Section: Introductionmentioning

confidence: 97%

Psychotropic Medication Nonadherence Among United States Latinos: A Comprehensive Literature Review

Lanouette¹,

Folsom²,

Sciolla³

et al. 2009

Psychiatric Services

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Objective Psychotropic medication nonadherence is a major public health problem, but few studies have focused on Latinos. We systematically reviewed the literature on rates of and factors influencing antipsychotic, antidepressant, or mood stabilizer nonadherence among United States (US) Latinos. Methods Data Sources: MEDLINE and PsycINFO were searched using keywords adherence, compliance, Latino, Hispanic, psychotropic, and related terms, as well as bibliographies from relevant reviews and studies. Study Selection: 21 studies met inclusion criteria: published since 1980 in English or Spanish; measured psychotropic medication nonadherence rates among US Latino adults. Data Abstraction: We examined articles for study design and objective, location, population, medication type, participant demographics, adherence measure, adherence rates, and factors related to adherence. Results and Conclusions In studies including Latinos and other ethnic groups, mean nonadherence rates were 41%, 31%, and 43% among Latinos, Euro-Americans, and African Americans respectively, with an overall effect size of 0.64 between Latinos and Euro-Americans. In studies including only Latinos, the mean nonadherence rate was 44%. Ten of 16 studies found Latinos had significantly lower adherence rates than Euro-Americans. Risk factors for nonadherence included being monolingual Spanish speaking, lacking health insurance, experiencing barriers to quality care, and having lower socioeconomic status. Protective factors included family support and psychotherapy. Rates of nonadherence to psychotropic medications were higher for Latinos than for Euro-Americans. Further investigation is needed into the potentially modifiable individual and societal level mechanisms of this discrepancy. Clinical and research interventions to improve adherence should be culturally appropriate and incorporate identified factors.

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“…La falta de adherencia al tratamiento farmacológi-co en la esquizofrenia se asocia a un mayor deterioro global, secundario a un mayor número de recaídas, exacerbación de síntomas psicóticos y mayor número de hospitalizaciones psiquiátricas a lo largo del padecimiento. 12,26,[43][44][45][46] La falta de adherencia al tratamiento no sólo impacta en el manejo de la enfermedad; un mayor número de hospitalizaciones implica mayores costos para el paciente y sus familiares en la atención especializada, así como un mayor uso de recursos del sistema de salud en términos del empleo de instalaciones hospitalarias y de más medicamentos concomitantes. [47][48][49][50] En el manejo de la esquizofrenia no sólo es importante considerar la eficacia de un medicamento en el control de los síntomas psicóticos.…”

Section: Discussionunclassified

Registro Electrónico de Adherencia al Tratamiento de Esquizofrenia en Latinoamérica (e-STAR): Resultados clínicos del uso de risperidona inyectable de liberación prolongada a dos años de seguimiento

Apiquian¹,

Córdoba²,

Louzã³

et al. 2013

Salud Ment

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SUMMARYSchizophrenia is a chronic psychiatric disorder associated to high healthcare costs mainly driven by inpatient care. Lack of adherence to antipsychotic treatment is a common reason for relapse and rehospitalization leading to poor prognosis and global functional impairment of patients. Risperidone long-acting injection (RLAI) has demonstrated its efficacy in treating symptoms of schizophrenia and offers the potential to improve adherence to treatment. ObjectiveTo determine clinical and functional efficacy of RLAI and use of health resources (eg., hospitalizations) in a 2-year follow up study among patients with schizophrenia from Latin America. MethodThe electronic Schizophrenia Treatment Adherence Registry (e-STAR) is an observational study of patients who start treatment with RLAI. Data from patients recruited in Mexico, Colombia and Brazil were collected retrospectively for one year prior to baseline, at baseline and every three months for 24 months. Hospitalization rates and treatment regime were registered. Efficacy was assessed using the Clinical Global Impression of Illness-Severity Scale (CGI-S), while the Global Assessment of Functioning (GAF) and the Personal and Social Performance (PSP) were used for the evaluation of functioning. ResultsSeventy-three patients completed the two-year follow-up. The proportion of patients hospitalized declined from 16.4% before treatment to 4.1% after 2 years of treatment with RLAI. Only 2.7% discontinued the treatment due to lack of efficacy. Significant improvements were reported in illness severity as well as in global functioning assessed by the CGI-S, GAF and PSP scales, respectively. DiscussionOur results give further support of the efficacy of RLAI for the treatment of schizophrenia. Additional to symptom severity reduction and functional recovery, improved treatment adherence and reduced hospitalization rates were observed with the use of RLAI. In a real world clinical setting, RLAI offer an effective long-term treatment for patients with schizophrenia, with a lower use of healthcare resources.Key words: Risperidone long-acting injection, schizophrenia, Latin America, treatment adherence. RESUMENLa esquizofrenia genera elevados costos al sistema de salud. La falta de adherencia al tratamiento es una de las principales causas de recaídas y hospitalizaciones en la esquizofrenia. Lo anterior conduce a un pobre pronóstico y deterioro funcional de los pacientes. La risperidona inyectable de liberación prolongada (RILP) ha demostrado su eficacia en el tratamiento de la esquizofrenia, ofreciendo la posibilidad de que los pacientes tengan una mayor adherencia terapéutica. ObjetivoDeterminar la eficacia y efecto sobre la funcionalidad y el uso de recursos hospitalarios de la RILP en una muestra de pacientes con esquizofrenia de América Latina a dos años de seguimiento. MétodoEl Registro Electrónico de Adherencia al Tratamiento de Esquizofrenia en Latinoamérica (e-STAR) es un estudio observacional del uso de la RILP en la esquizofrenia. Se reclutaron pacientes de M...

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The Relationship of Antipsychotic Medication Class and Adherence with Treatment Outcomes and Costs for Florida Medicaid Beneficiaries with Schizophrenia

Cited by 32 publications

References 44 publications

Duration of Pharmacotherapy with Long-Acting Injectable Risperidone in the Treatment of Schizophrenia

Duration of Pharmacotherapy with Long-Acting Injectable Risperidone in the Treatment of Schizophrenia

Psychotropic Medication Nonadherence Among United States Latinos: A Comprehensive Literature Review

Registro Electrónico de Adherencia al Tratamiento de Esquizofrenia en Latinoamérica (e-STAR): Resultados clínicos del uso de risperidona inyectable de liberación prolongada a dos años de seguimiento

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