Association between adherence to and persistence with atypical antipsychotics and psychiatric relapse among US Medicaid‐enrolled patients with schizophrenia. Issue 1 (7th January 2013)

• Record Type: Journal Article
• Authors: Panish, Jessica; Karve, Sudeep; Candrilli, Sean D.; Dirani, Riad
• Is Part Of: Journal of pharmaceutical health services research. Volume 4:Issue 1(2013:Mar.)
• Page Start: 29
• Page End: 39
• Publication Date: 2013-01-07
• Subjects: Pharmacy -- Research -- Periodicals; Drugs -- Research -- Periodicals; Medical care -- Research -- Periodicals; Public health -- Research -- Periodicals; Pharmaceutical industry -- Periodicals; Health Services Research -- Periodicals; Economics, Pharmaceutical -- Periodicals; 615.1072
• DOI: 10.1111/jphs.12004
• Languages: English
• ISSNs: 1759-8885

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="jphs12004-sec-0001" sec-type="section"> <title>Objective</title> <p>Assess association between adherence and persistence with second‐generation oral antipsychotics (SGOAs), psychiatric‐related relapse and healthcare utilization among patients with schizophrenia experiencing two or more psychiatric‐related relapses.</p> </sec> <sec id="jphs12004-sec-0002" sec-type="section"> <title>Methods</title> <p>A retrospective analysis of the US Medicaid Multi‐State Database for 2004–2008. Patients with schizophrenia (aged 18–64) with two or more psychiatric‐related relapses within 1 year after SGOA initiation were selected. Associations between a dichotomous measure of adherence and persistence with SGOAs and psychiatric‐related relapse and healthcare utilization were assessed using unadjusted and covariate‐adjusted regression models. No adjustment was made for multiplicity.</p> </sec> <sec id="jphs12004-sec-0003" sec-type="section"> <title>Key findings</title> <p>Study cohort consisted of 3714 patients with mean age of 42.6 years. Overall, 45% of patients were adherent and 50% persistent with SGOAs. Unadjusted and covariate‐adjusted analysis results suggested the 12‐month psychiatric‐related relapse rate was lower among adherent/persistent patients versus non‐adherent patients (unadjusted mean: 3.85 versus 4.13; <italic>P</italic> < 0.001; covariate‐adjusted incident rate ratio (IRR): 0.90; 95% confidence interval (CI): 0.86–0.94) and non‐persistent patients (unadjusted mean: 3.81 versus 4.21; <italic>P</italic> < 0.001; covariate‐adjusted IRR: 0.88; 95%CI: 0.84–0.92). Compared with non‐persistent patients, persistent patients had significantly lower rates of all‐cause inpatient admissions (IRR: 0.87; 95%CI: 0.82–0.93) and emergency department visits (IRR: 0.78; 95%CI: 0.73–0.85).</p> </sec> <sec id="jphs12004-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Although SGOAs have proven efficacy in lowering the rate of psychiatric‐related relapses, lower adherence and persistence rates may be an inhibiting factor in achieving optimal benefits from SGOAs. Future research is needed to assess whether newer antipsychotics with less‐frequent dosing may improve adherence among patients with schizophrenia.</p> </sec> </abstract>