Open AccessAssociation between adherence to and persistence with atypical antipsychotics and psychiatric relapse among US M edicaid‐enrolled patients with schizophrenia
Author(s) -
Panish Jessica,
Karve Sudeep,
Candrilli Sean D.,
Dirani Riad
Publication year - 2013
Publication title -
journal of pharmaceutical health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.244
H-Index - 15
eISSN - 1759-8893
pISSN - 1759-8885
DOI - 10.1111/jphs.12004
Subject(s) - medicine , medicaid , confidence interval , psychiatry , schizophrenia (object oriented programming) , persistence (discontinuity) , cohort , health care , geotechnical engineering , engineering , economics , economic growth
Objective Assess association between adherence and persistence with second‐generation oral antipsychotics ( SGOA s), psychiatric‐related relapse and healthcare utilization among patients with schizophrenia experiencing two or more psychiatric‐related relapses. Methods A retrospective analysis of the US M edicaid M ulti‐ S tate D atabase 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 SGOA s and psychiatric‐related relapse and healthcare utilization were assessed using unadjusted and covariate‐adjusted regression models. No adjustment was made for multiplicity. Key findings Study cohort consisted of 3714 patients with mean age of 42.6 years. Overall, 45% of patients were adherent and 50% persistent with SGOA s. 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; P < 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; P < 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). Conclusions Although SGOA s 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 SGOA s. Future research is needed to assess whether newer antipsychotics with less‐frequent dosing may improve adherence among patients with schizophrenia.