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Antipsychotic Medication Adherence and Healthcare Services Utilization in Two Cohorts of Patients with Serious Mental Illness

Authors Forma F, Green T, Kim S, Teigland C

Received 14 September 2019

Accepted for publication 29 January 2020

Published 14 February 2020 Volume 2020:12 Pages 123—132


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Samer Hamidi

Felicia Forma,1 Teresa Green,2 Seung Kim,2 Christie Teigland2

1Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA; 2Avalere Health — an Inovalon Company, Washington, DC, USA

Correspondence: Christie Teigland Email

Objective: To evaluate differences in patient characteristics and real-world outcomes in two distinct high-risk cohorts of patients with serious mental illness (SMI).
Methods: Retrospective cross-sectional analysis using a national multi-payer claims database. Two SMI cohorts identified by a technical expert panel—patients recently discharged (RD) from an SMI-related hospitalization and early episode (EE) patients—were evaluated for antipsychotic medication adherence, healthcare utilization, and spending patterns.
Results: The analysis included 51,705 patients with bipolar disorder, major depressive disorder, and schizophrenia. More than half were over age 46 and > 60% were female. Adherence to psychiatric medications was low (52.5% RD and 16.1% EE). More than half of RD and 100% of EE patients switched medications at least once annually, but 19% of RD patients switched ≥ 2 times compared to 14% of EE. The RD cohort (generally older and sicker) had higher psychiatric related utilization and higher annual costs (US$21,171 versus US$15,398). In both cohorts, women were more likely to have an emergency department (ED) and primary care provider (PCP) visit, but less likely to be hospitalized. Patients age < 46 were less likely to have a PCP visit and more likely to have an ED visit, but younger patients age 18– 24 were less likely to be hospitalized.
Conclusion: Efforts to manage SMI are confounded by heterogeneity and low adherence to treatment. By better understanding which patients are at higher risk for specific adverse outcomes, clinicians can target interventions more appropriately to reduce the significant burden of SMI.

Keywords: adherence, schizophrenia, major depressive disorder, bipolar disorder, healthcare utilization

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