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Access to credible information on schizophrenia patients’ medication adherence by prescribers can change their treatment strategies: evidence from an online survey of providers

Authors Shafrin J, May SG, Shrestha A, Ruetsch C, Gerlanc N, Forma F, Hatch A, Lakdawalla DN, Lindenmayer JP

Received 2 March 2017

Accepted for publication 1 May 2017

Published 27 June 2017 Volume 2017:11 Pages 1071—1081


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Video abstract presented by Jean-Pierre Lindenmayer.

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Jason Shafrin,1 Suepattra G May,1 Anshu Shrestha,1 Charles Ruetsch,2 Nicole Gerlanc,2 Felicia Forma,3 Ainslie Hatch,4 Darius N Lakdawalla,1,5 Jean-Pierre Lindenmayer6

1Precision Health Economics, Los Angeles, CA, 2Health Analytics, Columbia, MD, 3Otsuka Pharmaceutical Development & Commercialization, Inc., 4ODH, Inc., Princeton, NJ, 5Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 6Department of Psychiatry, New York University School of Medicine, New York, NY, USA

Objective: Overestimating patients’ medication adherence diminishes the ability of psychiatric care providers to prescribe the most effective treatment and to identify the root causes of treatment resistance in schizophrenia. This study was conducted to determine how credible patient drug adherence information (PDAI) might change prescribers’ treatment decisions.
Methods: In an online survey containing 8 clinical case vignettes describing patients with schizophrenia, health care practitioners who prescribe antipsychotics to patients with schizophrenia were instructed to choose a preferred treatment recommendation from a set of predefined pharmacologic and non-pharmacologic options. The prescribers were randomly assigned to an experimental or a control group, with only the experimental group receiving PDAI. The primary outcome was the prescribers’ treatment choice for each case. Between-group differences were analyzed using multinomial logistic regression.
Results: A convenience sample (n=219) of prescribers completed the survey. For 3 nonadherent patient vignettes, respondents in the experimental group were more likely to choose a long-acting injectable antipsychotic compared with those in the control group (77.7% experimental vs 25.8% control; P<0.001). For 2 adherent but poorly controlled patient vignettes, prescribers who received PDAI were more likely to increase the antipsychotic dose compared with the control group (49.1% vs 39.1%; P<0.001). For the adherent and well-controlled patient vignette, respondents in both groups made similar treatment recommendations across all choices (P=0.099), but respondents in the experimental arm were more likely to recommend monitoring clinical stability (87.2% experimental vs 75.5% control, reference group).
Conclusion: The results illustrate how credible PDAI can facilitate more appropriate clinical decisions for patients with schizophrenia.

Keywords: adherence, case vignettes, long-acting injectables, schizophrenia, treatment decision

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