Medication adherence levels and differential use of mental-health services in the treatment of schizophrenia

被引：9
作者：
Ascher-Svanum H. [1 ]
Zhu B. [1 ]
Faries D. [1 ]
Furiak N. [2 ]
Montgomery W. [1 ]
机构：
[1] US Outcomes Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN
[2] Medical Decision Modeling Inc., Indianapolis, IN
来源：
BMC Research Notes | / 2卷 / 1期
关键词：
Schizophrenia; Propensity Score; Psychiatric Hospitalization; Medication Possession Ratio; Adherence Level;
D O I：
10.1186/1756-0500-2-6
中图分类号：
学科分类号：
摘要：
Background. Adherence to antipsychotics for schizophrenia is associated with favorable clinical outcomes. This study compared annual mental-health service utilization by recent medication adherence levels for patients treated for schizophrenia, and assessed whether adherence levels change from pre- to post-psychiatric hospitalization. Methods. We analyzed data from a large prospective, non-interventional study of patients treated for schizophrenia in the United States, conducted between 7/1997 and 9/2003. Detailed mental-health resource utilization was systematically abstracted from medical records and augmented with patients' self report. Medication possession ratio (MPR) with any antipsychotic in the 6 months prior to enrollment was used to categorize patients as: adherent (MPR 80%, N = 1758), partially adherent (MPR 60% < 80%, N = 36), or non-adherent (MPR < 60%, N = 216). Group comparisons employed propensity score-adjusted bootstrap re-sampling methods with 1000 iterations, adjusting for baseline patient demographic and clinical characteristics identified a priori. Results. Adherent patients had a lower rate of psychiatric hospitalization compared with partially adherent and non-adherent patients (p < 0.001) and were more likely than non-adherent to engage in group therapy, individual therapy, and medication management. Most patients (92.0%) who were adherent in the 6 months prior to hospital admission continued to be adherent 6 months following hospitalization. However, 75.0% of previously partially adherent became adherent, and 38.7% of previously non-adherent became adherent following hospitalization. Conclusion. Adherence is associated with lower utilization of acute care services and greater engagement in outpatient mental-health treatment. Adherence is a potentially dynamic phenomenon, which may improve, at least temporarily, following patients' psychiatric hospitalizations. © 2009Ascher-Svanum et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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