The impact of antipsychotic adherence on acute care utilization

BMC Psychiatry

Research

Anthony J. Perkins¹  Leslie Hulvershorn²  Ashley Overley³  Malaz A. Boustani⁴  Farid Chekani⁵  Rezaul Khandker⁵  Anna Roberts⁶  Paul Dexter⁶  Craig A. Solid⁷ 

[1] Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA;Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA;Eskenazi Health, Indianapolis, IN, USA;Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA;Eskenazi Health, Indianapolis, IN, USA;Regenstrief Institute Inc, Indianapolis, IN, USA;Indiana University School of Medicine, Indianapolis, IN, USA;Merck & Co., Inc, Rahway, NJ, USA;Regenstrief Institute Inc, Indianapolis, IN, USA;Solid Research Group, LLC, St. Paul, MN, USA;

关键词: Antipsychotic;    Adherence;    Acute care utilization;    Schizophrenia;    Bipolar disorders;   

DOI  :  10.1186/s12888-023-04558-6

 received in 2022-07-14, accepted in 2022-10-17,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundNon-adherence to psychotropic medications is common in schizophrenia and bipolar disorders (BDs) leading to adverse outcomes. We examined patterns of antipsychotic use in schizophrenia and BD and their impact on subsequent acute care utilization.MethodsWe used electronic health record (EHR) data of 577 individuals with schizophrenia, 795 with BD, and 618 using antipsychotics without a diagnosis of either illness at two large health systems. We structured three antipsychotics exposure variables: the proportion of days covered (PDC) to measure adherence; medication switch as a new antipsychotic prescription that was different than the initial antipsychotic; and medication stoppage as the lack of an antipsychotic order or fill data in the EHR after the date when the previous supply would have been depleted. Outcome measures included the frequency of inpatient and emergency department (ED) visits up to 12 months after treatment initiation.ResultsApproximately half of the study population were adherent to their antipsychotic medication (a PDC ≥ 0.80): 53.6% of those with schizophrenia, 52.4% of those with BD, and 50.3% of those without either diagnosis. Among schizophrenia patients, 22.5% switched medications and 15.1% stopped therapy. Switching and stopping occurred in 15.8% and 15.1% of BD patients and 7.4% and 20.1% of those without either diagnosis, respectively. Across the three cohorts, non-adherence, switching, and stopping therapy were all associated with increased acute care utilization, even after adjusting for baseline demographics, health insurance, past acute care utilization, and comorbidity.ConclusionNon-continuous antipsychotic use is common and associated with high acute care utilization.

【 授权许可】

CC BY   
© The Author(s) 2023