Using Drug Claims Data to Assess the Relationship of Medication Adherence With Hospitalization and Costs

Svarstad, Bonnie L.; Shireman, Theresa I.; Sweeney, J

doi:10.1176/appi.ps.52.6.805

Cited by 252 publications

(219 citation statements)

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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%

“…Therefore, it was difficult to make comparisons, and it was not feasible to pool the quantitative results on the relationship between nonadherence and increased risk of hospitalization. However, regardless of the heterogeneity in adherence measures used, all studies consistently showed a link between lower adherence rates and higher hospitalization risk [Ahn et al 2008;Eaddy et al 2005;Gilmer et al 2004;Karve et al 2009;Knapp et al 2004;Laan et al 2010;Law et al 2008;Morken et al 2008;Svarstad et al 2001].…”

Section: Consequences To Patientsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Consequences To Patientsmentioning

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

View full text Add to dashboard Cite

show abstract

“…Non-adherence with prescribed therapeutics remains the highest predictor of patient relapse and rehospitalization (Ayuso-Gutierrez and del Rio Vega 1997; Harris et al 2002;Lieberman et al 2005;Olfson et al 2000;Svarstad et al 2001). Up to 55% of individuals with schizophrenia have significant difficulties adhering to treatment (Corriss et al 1999).…”

Section: Introductionmentioning

confidence: 99%

“…Up to 55% of individuals with schizophrenia have significant difficulties adhering to treatment (Corriss et al 1999). Non-adherent patients are twice as likely to undergo rehospitalization from relapse (Svarstad et al 2001), resulting in a poor quality of life. A Medicaid study found that only 11.6% of treated patients achieved 1 year of uninterrupted antipsychotic medication therapy (McCombs et al 1999).…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetic and behavioral characterization of a long-term antipsychotic delivery system in rodents and rabbits

et al. 2006

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. Pharmacokinetic and behavioral characterization of a longterm antipsychotic delivery system in rodents and rabbits. Retrieved from http://repository.upenn.edu/mse_papers/122Pharmacokinetic and behavioral characterization of a longterm antipsychotic delivery system in rodents and rabbits AbstractRationale: Non-adherence with medication remains the major correctable cause of poor outcome in schizophrenia. However, few treatments have addressed this major determinant of outcome with novel longterm delivery systems.Objectives: The aim of this study was to provide biological proof of concept for a long-term implantable antipsychotic delivery system in rodents and rabbits.Materials and methods: Implantable formulations of haloperidol were created using biodegradable polymers. Implants were characterized for in vitro release and in vivo behavior using prepulse inhibition of startle in rats and mice, as well as pharmacokinetics in rabbits.Results: Behavioral measures demonstrate the effectiveness of haloperidol implants delivering 1 mg/kg in mice and 0.6 mg/kg in rats to block amphetamine (10 mg/kg) in mice or apomorphine (0.5 mg/kg) in rats. Additionally, we demonstrate the pattern of release from single polymer implants for 1 year in rabbits. Conclusions:The current study suggests that implantable formulations are a viable approach to providing longterm delivery of antipsychotic medications in vivo using animal models of behavior and pharmacokinetics. In contrast to depot formulations, implantable formulations could last 6 months or longer. Additionally, implants can be removed throughout the delivery interval, offering a degree of reversibility not available with depot formulations. AbstractRationale Non-adherence with medication remains the major correctable cause of poor outcome in schizophrenia. However, few treatments have addressed this major determinant of outcome with novel long-term delivery systems. Objectives The aim of this study was to provide biological proof of concept for a long-term implantable antipsychotic delivery system in rodents and rabbits. Materials and methods Implantable formulations of haloperidol were created using biodegradable polymers. Implants were characterized for in vitro release and in vivo behavior using prepulse inhibition of startle in rats and mice, as well as pharmacokinetics in rabbits. Results Behavioral measures demonstrate the effectiveness of haloperidol implants delivering 1 mg/kg in mice and 0.6 mg/kg in rats to block amphetamine (10 mg/kg) in mice or apomorphine (0.5 mg/kg) in rats. Additionally, we demonstrate the pattern of release from single polymer implants for 1 year in rabbits. Conclusions The current study suggests that implantable formulations are a viable approach to providing long-term delivery of antipsychotic medications in vivo using animal models of behavior and pharmacokinetics. In contrast to depot formulations, implantable formulations could last 6 months or longer. Additionally, implants can be removed throughout the delivery interval, offering a ...

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“…Although symptoms remain a concern for some on these medications (Judd et al, 2003), evidence has accrued to suggest that mood-stabilizing medications substantially diminish symptoms as well as hospitalization rates (cf., Smith, Cornelius, Warnock, Bell, & Young, 2007). Despite this, estimates suggest that one-third to one-half of patients with bipolar disorder discontinue medication treatment over time (Basco & Rush, 1995;Svarstad, Shireman, & Sweeney, 2001). Lack of adherence to mood stabilizers has been shown to contribute to poorer course of disorder and more frequent hospitalization (Scott & Pope, 2002).…”

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confidence: 99%

Development of the treatment attitudes questionnaire in bipolar disorder

Johnson

Fulford

2008

J Clin Psychol

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Despite the success of pharmacotherapy in the management of bipolar disorder, as many as one-half of those in treatment discontinue their medication over time. Currently, no self-report measure is available that predicts treatment engagement in bipolar disorder. The goal of the current study was to develop a measure of awareness of symptoms and attitudes toward treatment among those with bipolar disorder. Sixty-six participants diagnosed with bipolar I disorder on the SCID completed the Treatment Attitudes Questionnaire (TAQ) and were then followed for up to 2 years to assess symptom levels. Medication data were available for 37 participants. Analyses of the TAQ were conducted to examine reliability, predictors of subscales, and how well scores predicted medication and symptom levels over time. Results indicate that previous episodes of depression, but not episodes of mania, correlated with increased scores on the Insight and the Enjoyment of Mania subscales. Scores on the Nonbiological Attributions subscale predicted lower levels of lithium as well as increased depressive symptoms over time. Although the current study includes limited measurement of treatment engagement and a small sample size, this easily administered scale may help treatment planning for those with bipolar disorder. Keywords bipolar disorder; treatment adherence; treatment attitudes; treatment attitudes questionnaire "I had become addicted to my high moods; I had become dependent upon their intensity, euphoria, assuredness, and their infectious ability to induce high moods and enthusiasms in other people" (Jamison, 1996).With the introduction of lithium treatment in the late 1960s (Baastrup & Schou, 1967), and the development of other pharmacotherapy approaches, including divalproex, carbamazepine, lamotrigine, and atypical antipsychotics, a range of effective treatments are now available (Muzina & Calabrese, 2005). Although symptoms remain a concern for some on these medications (Judd et al., 2003), evidence has accrued to suggest that mood-stabilizing medications substantially diminish symptoms as well as hospitalization rates (cf., Smith, Cornelius, Warnock, Bell, & Young, 2007). Despite this, estimates suggest that one-third to one-half of patients with bipolar disorder discontinue medication treatment over time (Basco & Rush, 1995;Svarstad, Shireman, & Sweeney, 2001). Lack of adherence to mood stabilizers has been shown to contribute to poorer course of disorder and more frequent hospitalization (Scott & Pope, 2002). Thus, a fundamental challenge in the effective care of bipolar disorder appears to be promoting medication adherence. © 2008 Wiley Periodicals, Inc. Correspondence concerning this article should be addressed to: Daniel Fulford, 5665 Ponce de Leon Blvd, Coral Gables, FL; e-mail: dfulford@psy.miami.edu. NIH Public AccessAuthor Manuscript J Clin Psychol. Author manuscript; available in PMC 2010 January 29. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptTo date, adherence has been a fairly p...

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Using Drug Claims Data to Assess the Relationship of Medication Adherence With Hospitalization and Costs

Abstract: The availability of drug claims data and the ability to use them in predictive analyses make them a potentially useful data source in studies of medication adherence among persons with severe mental illness.

Cited by 252 publications

References 24 publications

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

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

Pharmacokinetic and behavioral characterization of a long-term antipsychotic delivery system in rodents and rabbits

Development of the treatment attitudes questionnaire in bipolar disorder

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