This study evaluated treatment adherence among patients with schizophrenia receiving atypical and typical antipsychotics. Claims data for 7017 treatment episodes of commercially insured patients with schizophrenia (ICD-9-CM) receiving antipsychotics, covering the period from January 1999 through August 2003, were assessed. Overall adherence was evaluated by adherence intensity (medication possession ratio) and treatment duration (length of treatment episode). Pair-wise comparisons of the individual atypicals and a combined group of leading typical antipsychotics were undertaken using multiple regression, adjusting for differing patient characteristics. Each atypical antipsychotic demonstrated a significantly higher adherence intensity than the combined typicals, while quetiapine demonstrated a significantly greater adherence intensity than risperidone and olanzapine. None of the atypicals showed treatment durations significantly different from the typicals. While the small improvements in adherence intensity among atypical agents do not appear to be clinically important, they may reflect an underlying, stronger tendency to use filled prescriptions.
"In a retrospective claims database analysis (N=5,683), the use of any of four atypical antipsychotics included in the study was associated with significantly higher patient-adjusted medication-possession ratios compared with the use of typical antipsychotics (P≤0.049).19 However, there was no significant difference between typical and atypical antipsychotics with respect to treatment duration.19 In a study of 150 parolees on antipsychotic medication, patients prescribed an atypical antipsychotic were four times more likely to be adherent than those prescribed a typical antipsychotic.5 "
[Show abstract][Hide abstract] ABSTRACT: Purpose
In patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams.
Materials and methods
A systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia.
Of 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports corresponding reductions in relapse rates, inpatient admissions, and associated costs.
Optimization of medication and involvement of caregivers are important to promoting adherence. A multidisciplinary team approach may be invaluable in identifying barriers to adherence and helping schizophrenia patients overcome them.
"Some previous studies have reported modestly-increased rates of adherence with atypical antipsychotic medication (i.e. Dolder et al. 2002; Gianfrancesco et al. 2006; Lang et al. 2010; Perkins 2002; Voruganti et al. 2000), while other studies have opposing findings (Valenstein et al. 2004). It is surprising to note that only 28% of participants in this study were prescribed atypical antipsychotics, which is very low in comparison to the 2006–2007 rates of 67% reported by NICE (2008) in the UK. "
[Show abstract][Hide abstract] ABSTRACT: The purpose of the present study was to examine the factors affecting adherence to antipsychotic medication in patients with schizophrenia registered with a community psychiatric nursing service in Hong Kong. The study was a cross-sectional observational survey; symptoms, drug attitudes, insight, side-effects, and sociodemographic characteristics were measured and explored in terms of their relationship with medication adherence. A total of 584 patients who were visited by community psychiatric nurses (CPN) participated, and 30% of these patients were non-adherent with their antipsychotic medication. Positive treatment attitudes, awareness of the need for treatment, being prescribed clozapine, receiving state benefits, lower levels of symptoms, and fewer side-effects were associated with adherence. The findings from this study suggest that the clinical efforts of CPN to improve adherence should aim to help patients amplify the personal relevance of treatment and modify patients' attitudes towards medication.
International journal of mental health nursing 06/2012; 22(1). DOI:10.1111/j.1447-0349.2012.00830.x · 1.95 Impact Factor
"Adherence to therapy is also an important challenge in the management of schizophrenia. The adverse effects of antipsychotic treatment, as well as restrictive dosing regimens (such as the requirement to take drugs with food or multiple times a day), are a few of several factors that may compromise oral antipsychotic treatment adherence (Cooper et al, 2007; Gianfrancesco et al, 2006; Keith and Kane, 2003). General dissatisfaction with oral antipsychotic therapy was underscored by results from the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) study, which indicated that although 10–18% of patients discontinued initial treatment because of adverse events, Received 1 January 2010; revised 12 April 2010; accepted 4 May 2010 Previous presentations: Data from this study were presented at the American Psychiatric Association 161st Annual Meeting, 3–8 May 2008, and the 60th Institute of Psychiatric Services Annual Meeting, 2–5 October 2008. "
[Show abstract][Hide abstract] ABSTRACT: Paliperidone palmitate is a long-acting injectable antipsychotic agent. This 13-week, multicenter, randomized (1 : 1 : 1 : 1), double-blind, parallel-group study evaluated the efficacy, safety, and tolerability of fixed 25, 50, and 100 milligram equivalent (mg equiv.) doses of paliperidone palmitate vs placebo administered as gluteal injections on days 1 and 8, then every 4 weeks (days 36 and 64) in 518 adult patients with schizophrenia. The intent-to-treat analysis set (N=514) was 67% men and 67% White, with a mean age of 41 years. All paliperidone palmitate dose groups showed significant improvement vs placebo in the Positive and Negative Syndrome Scale (PANSS) total score (primary efficacy measure; 25 and 50 mg equiv., p=0.02; 100 mg equiv., p<0.001), as well as Clinical Global Impression Severity scores (p< or =0.006) and PANSS negative and positive symptom Marder factor scores (p< or =0.04). The Personal and Social Performance scale showed no significant difference between treatment groups. The overall incidence of treatment-emergent adverse events was similar between groups. Parkinsonism, the most frequently reported extrapyramidal symptom, was reported at similar rates for placebo (5%) and paliperidone palmitate (5-6% across doses). The mean body mass index and mean weight showed relatively small dose-related increases during paliperidone palmitate treatment. Investigator-evaluated injection-site pain, swelling, redness, and induration were similar across treatment groups; scores for patient-evaluated injection-site pain (visual analog scale) were similar across groups and diminished with time. All doses of once-monthly paliperidone palmitate were efficacious and generally tolerated, both locally and systemically. Paliperidone palmitate offers the potential to improve outcomes in adults with symptomatic schizophrenia.
Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 09/2010; 35(10):2072-82. DOI:10.1038/npp.2010.79 · 7.05 Impact Factor
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