EFFECT OF AN INSTITUTIONAL MEDICATION ADHERENCE PROGRAM FOR LONG-ACTING INJECTABLE RISPERIDONE ON ADHERENCE AND PSYCHIATRIC HOSPITALIZATIONS: EVIDENCE FROM A PROSPECTIVE COHORT STUDY
Main Article Content
Keywords
Medication Adherence Program, Adherence, Schizophrenia, Hospitalization, Antipsychotics, Relapse
Abstract
Background
Long-acting injectable (LAI) atypical antipsychotics are associated with improved adherence and reduced relapse rates in schizophrenia but reminder-based interventions may further improve outcomes.
Objectives
To assess an institutional medication adherence program’s (IMAP) effectiveness on adherence and psychiatric hospitalizations among schizophrenia patients taking risperidone LAI (RLAI).
Methods
Between 2009 and 2010, we recruited patients meeting DSM-IV criteria for schizophrenia treated with RLAI receiving outpatient care from psychiatric centres in France. The IMAP consisted of calling patients 48 hours prior to their scheduled RLAI injections and within 3 days of a missed appointment. Centres applying the IMAP to ?50% of scheduled patient injections were deemed compliant. Patients were followed up to one year for adherence (?80% of scheduled RLAI injections received within 5 days of the scheduled date) and psychiatric hospitalizations.
Results
Among 506 patients recruited from 36 centres, the hospitalization rate was 32.5 per 100 person-years. 15 centres treating 243 patients were IMAP compliant and 21 centres treating 263 patients were not. IMAP compliance was associated with lower psychiatric hospitalization rates (crude RR: 0.64 [95% CI: 0.44–0.93]; adjusted RR: 0.78 [95% CI: 0.47–1.27]). Nearly 75% of patients were adherent to RLAI. While patient adherence had little impact on hospitalization rates (adjusted RR: 0.92 [95% CI: 0.59–1.44]), IMAP compliance was more effective among non-adherent (adjusted RR: 0.45 [95% CI: 0.16–1.28]) than adherent (adjusted RR: 0.88 [95% CI: 0.51–1.53]) patients.
Conclusions
IMAPs may improve patient adherence and reduce psychiatric hospitalizations, particularly among patients with difficulties adhering to LAI antipsychotics.
Long-acting injectable (LAI) atypical antipsychotics are associated with improved adherence and reduced relapse rates in schizophrenia but reminder-based interventions may further improve outcomes.
Objectives
To assess an institutional medication adherence program’s (IMAP) effectiveness on adherence and psychiatric hospitalizations among schizophrenia patients taking risperidone LAI (RLAI).
Methods
Between 2009 and 2010, we recruited patients meeting DSM-IV criteria for schizophrenia treated with RLAI receiving outpatient care from psychiatric centres in France. The IMAP consisted of calling patients 48 hours prior to their scheduled RLAI injections and within 3 days of a missed appointment. Centres applying the IMAP to ?50% of scheduled patient injections were deemed compliant. Patients were followed up to one year for adherence (?80% of scheduled RLAI injections received within 5 days of the scheduled date) and psychiatric hospitalizations.
Results
Among 506 patients recruited from 36 centres, the hospitalization rate was 32.5 per 100 person-years. 15 centres treating 243 patients were IMAP compliant and 21 centres treating 263 patients were not. IMAP compliance was associated with lower psychiatric hospitalization rates (crude RR: 0.64 [95% CI: 0.44–0.93]; adjusted RR: 0.78 [95% CI: 0.47–1.27]). Nearly 75% of patients were adherent to RLAI. While patient adherence had little impact on hospitalization rates (adjusted RR: 0.92 [95% CI: 0.59–1.44]), IMAP compliance was more effective among non-adherent (adjusted RR: 0.45 [95% CI: 0.16–1.28]) than adherent (adjusted RR: 0.88 [95% CI: 0.51–1.53]) patients.
Conclusions
IMAPs may improve patient adherence and reduce psychiatric hospitalizations, particularly among patients with difficulties adhering to LAI antipsychotics.
References
1. Velligan DI, Weiden PJ, Sajatovic M, et al. The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatr 2009;70 Suppl 4:1–46.
2. Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatr 2002;63:892–909.
3. Klingberg S, Schneider S, Wittorf A, Buchkremer G, Wiedemann G. Collaboration in outpatient antipsychotic drug treatment: analysis of potentially influencing factors. Psychiatr Res 2008;161:225–34.
4. Leucht S, Heres S. Epidemiology, clinical consequences, and psychosocial treatment of nonadherence in schizophrenia. J Clin Psychiatr 2006;67 Suppl 5:3–8.
5. Ascher-Svanum H, Faries DE, Zhu B, et al. Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatr 2006;67:453–60.
6. Weiden PJ, Kozma C, Grogg A, Locklear J. Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatr serv 2004;55:886–91.
7. Olivares JM, Rodriguez-Morales A, Diels J, et al. Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR). Eur Psychiatr 2009;24:287–96.
8. Brnabic AJ, Kelin K, Ascher-Svanum H, et al. Medication discontinuation with depot and oral antipsychotics in outpatients with schizophrenia: comparison of matched cohorts from a 12-month observational study. Int J Clin Pract 2011;65:945–53.
9. Shi L, Ascher-Svanum H, Zhu Bet al. Characteristics and use patterns of patients taking first-generation depot antipsychotics or oral antipsychotics for schizophrenia. Psychiatr Serv 2007;58:482–88.
10. Zhu B, Ascher-Svanum H, Shi L, et al. Time to discontinuation of depot and oral first-generation antipsychotics in the usual care of schizophrenia. Psychiatr Serv 2008;59:315–17.
11. Velligan DI, Diamond PM, Mintz J, et al. The use of individually tailored environmental supports to improve medication adherence and outcomes in schizophrenia. Schizophr Bull 2008;34:483–93.
12. Montes JM, Medina E, Gomez-Beneyto M, Maurino J. A short message service (SMS)-based strategy for enhancing adherence to antipsychotic medication in schizophrenia. Psychiatr Res 2012;200:89–95.
13. Valenstein M, Kavanagh J, Lee T, et al. Using a pharmacy-based intervention to improve antipsychotic adherence among patients with serious mental illness. Schizophr Bull 2011;37:727–36.
14. Burgoyne RW, Acosta FX, Yamamoto J. Telephone prompting to increase attendance at a Psychiatric Outpatient Clinic. Am J Psychiatr 1983;140:345–47.
15. MacDonald J, Brown N, Ellis P. Using telephone prompts to improve initial attendance at a community mental health center. Psychiatr Serv 2000;51:812–14.
16. Reda S, Makhoul S. Prompts to encourage appointment attendance for people with serious mental illness. Cochrane Database Syst Rev 2001;2:CD002085.
17. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation 2009;119:3028–3035.
18. Grimaldi-Bensouda L, Rouillon F, Astruc B, et al. Does long-acting injectable risperidone make a difference to the real-life treatment of schizophrenia? Results of the Cohort for the General study of Schizophrenia (CGS). Schizophr Res 2012;134:187–94.
19. Doshi JA, Pettit AR, Stoddard JJ, et al. Concurrent oral antipsychotic drug use among schizophrenia patients initiated on long-acting injectable antipsychotics post-hospital discharge. J Clin Psychopharmacol 2015;35:442–46.
20. Gaebel W, Schreiner A, Bergmans P, et al. Relapse prevention in schizophrenia and schizoaffective disorder with risperidone long-acting injectable vs quetiapine: results of a long-term, open-label, randomized clinical trial. Neuropsychopharmacology 2010;35:2367–77.
21. Leucht C, Heres S, Kane JM, et al. Oral versus depot antipsychotic drugs for schizophrenia--a critical systematic review and meta-analysis of randomised long-term trials. Schizophr Res 2011;127:83–92.
22. Tiihonen J, Haukka J, Taylor M, et al. A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatr 2011;168:603–609.
23. Olivares JM, Rodriguez-Martinez A, Buron JA, et al. Cost-effectiveness analysis of switching antipsychotic medication to long-acting injectable risperidone in patients with schizophrenia: a 12- and 24-month follow-up from the e-STAR database in Spain. Appl Health Econ Health Polic 2008;6:41–53.
24. Kishimoto T, Robenzadeh A, Leucht C, et al. Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials. Schizophr Bull 2014;40:192–213.
25. Rosenheck RA, Krystal JH, Lew R, et al. Long-acting risperidone and oral antipsychotics in unstable schizophrenia. NEJM 2011;364:842–51.
26. Kane JM, Detke HC, Naber D, et al. Olanzapine long-acting injection: a 24-week, randomized, double-blind trial of maintenance treatment in patients with schizophrenia. Am J Psychiatr 2010;167:181–89.
27. Kirson NY, Weiden PJ, Yermakov S, et al. Efficacy and effectiveness of depot versus oral antipsychotics in schizophrenia: synthesizing results across different research designs. J Clin Psychiatr 2013;74:568–75.
28. Priebe S, Yeeles K, Bremner S, et al. Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial. BMJ 2013;347:f5847.
29. Sajatovic M, Levin J, Ramirez LF, et al. Prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. J Clin Psychiatr 2013;74:1249–55.
2. Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatr 2002;63:892–909.
3. Klingberg S, Schneider S, Wittorf A, Buchkremer G, Wiedemann G. Collaboration in outpatient antipsychotic drug treatment: analysis of potentially influencing factors. Psychiatr Res 2008;161:225–34.
4. Leucht S, Heres S. Epidemiology, clinical consequences, and psychosocial treatment of nonadherence in schizophrenia. J Clin Psychiatr 2006;67 Suppl 5:3–8.
5. Ascher-Svanum H, Faries DE, Zhu B, et al. Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatr 2006;67:453–60.
6. Weiden PJ, Kozma C, Grogg A, Locklear J. Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatr serv 2004;55:886–91.
7. Olivares JM, Rodriguez-Morales A, Diels J, et al. Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR). Eur Psychiatr 2009;24:287–96.
8. Brnabic AJ, Kelin K, Ascher-Svanum H, et al. Medication discontinuation with depot and oral antipsychotics in outpatients with schizophrenia: comparison of matched cohorts from a 12-month observational study. Int J Clin Pract 2011;65:945–53.
9. Shi L, Ascher-Svanum H, Zhu Bet al. Characteristics and use patterns of patients taking first-generation depot antipsychotics or oral antipsychotics for schizophrenia. Psychiatr Serv 2007;58:482–88.
10. Zhu B, Ascher-Svanum H, Shi L, et al. Time to discontinuation of depot and oral first-generation antipsychotics in the usual care of schizophrenia. Psychiatr Serv 2008;59:315–17.
11. Velligan DI, Diamond PM, Mintz J, et al. The use of individually tailored environmental supports to improve medication adherence and outcomes in schizophrenia. Schizophr Bull 2008;34:483–93.
12. Montes JM, Medina E, Gomez-Beneyto M, Maurino J. A short message service (SMS)-based strategy for enhancing adherence to antipsychotic medication in schizophrenia. Psychiatr Res 2012;200:89–95.
13. Valenstein M, Kavanagh J, Lee T, et al. Using a pharmacy-based intervention to improve antipsychotic adherence among patients with serious mental illness. Schizophr Bull 2011;37:727–36.
14. Burgoyne RW, Acosta FX, Yamamoto J. Telephone prompting to increase attendance at a Psychiatric Outpatient Clinic. Am J Psychiatr 1983;140:345–47.
15. MacDonald J, Brown N, Ellis P. Using telephone prompts to improve initial attendance at a community mental health center. Psychiatr Serv 2000;51:812–14.
16. Reda S, Makhoul S. Prompts to encourage appointment attendance for people with serious mental illness. Cochrane Database Syst Rev 2001;2:CD002085.
17. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation 2009;119:3028–3035.
18. Grimaldi-Bensouda L, Rouillon F, Astruc B, et al. Does long-acting injectable risperidone make a difference to the real-life treatment of schizophrenia? Results of the Cohort for the General study of Schizophrenia (CGS). Schizophr Res 2012;134:187–94.
19. Doshi JA, Pettit AR, Stoddard JJ, et al. Concurrent oral antipsychotic drug use among schizophrenia patients initiated on long-acting injectable antipsychotics post-hospital discharge. J Clin Psychopharmacol 2015;35:442–46.
20. Gaebel W, Schreiner A, Bergmans P, et al. Relapse prevention in schizophrenia and schizoaffective disorder with risperidone long-acting injectable vs quetiapine: results of a long-term, open-label, randomized clinical trial. Neuropsychopharmacology 2010;35:2367–77.
21. Leucht C, Heres S, Kane JM, et al. Oral versus depot antipsychotic drugs for schizophrenia--a critical systematic review and meta-analysis of randomised long-term trials. Schizophr Res 2011;127:83–92.
22. Tiihonen J, Haukka J, Taylor M, et al. A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatr 2011;168:603–609.
23. Olivares JM, Rodriguez-Martinez A, Buron JA, et al. Cost-effectiveness analysis of switching antipsychotic medication to long-acting injectable risperidone in patients with schizophrenia: a 12- and 24-month follow-up from the e-STAR database in Spain. Appl Health Econ Health Polic 2008;6:41–53.
24. Kishimoto T, Robenzadeh A, Leucht C, et al. Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials. Schizophr Bull 2014;40:192–213.
25. Rosenheck RA, Krystal JH, Lew R, et al. Long-acting risperidone and oral antipsychotics in unstable schizophrenia. NEJM 2011;364:842–51.
26. Kane JM, Detke HC, Naber D, et al. Olanzapine long-acting injection: a 24-week, randomized, double-blind trial of maintenance treatment in patients with schizophrenia. Am J Psychiatr 2010;167:181–89.
27. Kirson NY, Weiden PJ, Yermakov S, et al. Efficacy and effectiveness of depot versus oral antipsychotics in schizophrenia: synthesizing results across different research designs. J Clin Psychiatr 2013;74:568–75.
28. Priebe S, Yeeles K, Bremner S, et al. Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial. BMJ 2013;347:f5847.
29. Sajatovic M, Levin J, Ramirez LF, et al. Prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. J Clin Psychiatr 2013;74:1249–55.