Adherence and outcomes associated with copayment burden in schizophrenia: A cross-sectional survey

Bristol-Myers Squibb, Plainsboro, NJ, USA.
Journal of Medical Economics (Impact Factor: 1.58). 03/2010; 13(2):185-92. DOI: 10.3111/13696991003723023
Source: PubMed


Assess the association of schizophrenia patients' perceived copayment burden with medication adherence and outcomes.
Patients with schizophrenia (aged 18+) completed self-reported questionnaires. Analyses included those currently using a second-generation antipsychotic (SGA) with no exposure to clozapine or depot formulation antipsychotics. Adherence was assessed using the Morisky Medication Adherence Scale (MMAS). Outcomes included emergency room (ER) use, hospitalization, attempted suicide, missed work due to health, and experiencing severe psychological distress. Logistic regression was used to adjust for demographics, health characteristics, psychotropic medication use, and insurance status.
Of 351 schizophrenia patients, 39% perceived copayment burden. These patients were less than half as likely to have complete adherence [OR = 0.427; 95% CI:0.257, 0.711; p = 0.001] Copayment burden was associated with greater likelihood of ER use, [OR = 2.157; 95% CI:(1.322, 3.520); p = 0.002], hospitalization [OR = 2.512; 95% CI: (1.475, 4.277); p < 0.001], attempted suicide[OR = 2.385; 95% CI: (1.156, 4.920); p = 0.019], severe psychological distress [OR = 1.833; 95% CI:1.092, 3.075; p = 0.022] and greater likelihood of missing work [OR = 7.193; 95% CI: 2.554, 20.256; p < 0.001].
Copayment burden is associated with poorer medication adherence and outcomes. Formularies that reduce copayment burden for SGAs may positively affect medication adherence and outcomes among schizophrenia patients.
Patient data were self-reported, which may have introduced additional bias in the study measures. Also, the use of a cross-sectional design precludes causal inference and the use of the current sampling methodology (both interview and Internet panel) might impact the ability to generalize the results to the broader population.

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Available from: Edward Kim
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    • "Patient access to health care services (affected by geographic location, transportation difficulties, and cultural or language issues) may influence patient adherence to antipsychotic therapy.8 Patients with schizophrenia are frequently unemployed and/or in poverty,30,31 which may contribute to nonadherence caused by the financial burden of medication (eg, medication copayments).30,32 Even small increases in insurance copayments have been associated with declining adherence and corresponding increases in psychiatric hospital admissions.32 "
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    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. Results 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. Conclusion 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.
    Full-text · Article · May 2014 · Patient Preference and Adherence
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    • "With occasional episodes of unintentional non-adherence, patients may be testing a medication’s effectiveness or gauging symptom status without the medication. Others have suggested that reports of forgetfulness in taking medications may be a proxy for reduced motivation [67], having doubts about the prescribed therapy [68], or having low perceived need for the medication [29,69]. Our analyses support these interpretation as all three medication beliefs scales were significantly associated with reports of forgetfulness, carelessness, and any unintentional non-adherence. "
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    ABSTRACT: Unintentional non-adherence has been characterized as passively inconsistent medication-taking behavior (forgetfulness or carelessness). Our objectives were to: (1) study the prevalence and predictors of unintentional non-adherence; and (2) explore the interrelationship between intentional and unintentional non-adherence in relation to patients' medication beliefs. We conducted a cross-sectional survey of adults with asthma, hypertension, diabetes, hyperlipidemia, osteoporosis, or depression from the Harris Interactive Chronic Illness Panel. The analytic sample for this study included 24,017 adults who self-identified themselves as persistent to prescription medications for their index disease. They answered three questions on unintentional non-adherence (forgot, ran out, being careless), 11 questions on intentional non-adherence, and three multi-item scales assessing perceived need for medication (k = 10), perceived medication concerns (k = 6), and perceived medication affordability (k = 4). Logistic regression was used to model predictors of each unintentional non-adherence behavior. Baron and Kenny's regression approach was used to test the mediational effect of unintentional non-adherence on the relationship between medication beliefs and intentional non-adherence. Bootstrapping was employed to confirm the statistical significance of these results. For the index disease, 62% forgot to take a medication, 37% had run out of the medication, and 23% were careless about taking the medication. Common multivariate predictors (p < .001) of the three behaviors were: (1) lower perceived need for medications; (2) more medication affordability problems; (3) worse self-rated health; (4) diabetes or osteoporosis (relative to hypertension); and (5) younger age. Unique statistically-significant predictors of the three behaviors were: (a) 'forgot to take medications' - greater concerns about the index medication and male gender; (b) 'run out of medications' - non-white race, asthma, and higher number of total prescription medications; (c) 'being careless' - greater medication concerns. Mediational tests confirmed the hypothesis that the effect of medication beliefs (perceived need, concerns, and affordability) on intentional non-adherence is mediated through unintentional non-adherence. For our study sample, unintentional non-adherence does not appear to be random and is predicted by medication beliefs, chronic disease, and sociodemographics. The data suggests that the importance of unintentional non-adherence may lie in its potential prognostic significance for future intentional non-adherence. Health care providers may consider routinely inquiring about unintentional non-adherence in order to proactively address patients' suboptimal medication beliefs before they choose to discontinue therapy all together.
    Full-text · Article · Apr 2012 · BMC Health Services Research
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    • "This original survey, conducted between December 2007 and February 2008, was initiated to understand the treatments, attitudes, health behaviors, and health outcomes among patients with schizophrenia. The data generated from this survey has been used in several previous studies, each of which has outlined the methods in some detail [4,19]. Briefly, patients were convenience sampled in one of two ways to participate in a self-administered survey to create the dataset: (1) patients who reported having schizophrenia in an Internet-based consumer panel (Lightspeed Research Ailment Panel) were randomly sent an invitation to participate in a web-based questionnaire via email, and (2) patients were also recruited from grassroots campaigns and newspaper advertising to arrive at a central interview facility to take a paper copy of the survey instrument. "
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    ABSTRACT: Antipsychotic medications often have a variety of side effects, however, it is not well understood how the presence of specific side effects correlate with adherence in a real-world setting. The aim of the current study was to examine the relationship between these variables among community-dwelling patients with schizophrenia. Data were analyzed from a 2007-2008 nationwide survey of adults who self-reported a diagnosis of schizophrenia and were currently using an antipsychotic medication (N = 876). The presence of side effects was defined as those in which the patient reported they were at least "somewhat bothered". Adherence was defined as a score of zero on the Morisky Medication Adherence Scale. To assess the relationship between side effects and adherence, individual logistic regression models were fitted for each side effect controlling for patient characteristics. A single logistic regression model assessed the relationship between side effect clusters and adherence. The relationships between adherence and health resource use were also examined. A majority of patients reported experiencing at least one side effect due to their medication (86.19%). Only 42.5% reported complete adherence. Most side effects were associated with a significantly reduced likelihood of adherence. When grouped as side effect clusters in a single model, extra pyramidal symptoms (EPS)/agitation (odds ratio (OR) = 0.57, p = 0.0007), sedation/cognition (OR = 0.70, p = 0.033), prolactin/endocrine (OR = 0.69, p = 0.0342), and metabolic side effects (OR = 0.64, p = 0.0079) were all significantly related with lower rates of adherence. Those who reported complete adherence to their medication were significantly less likely to report a hospitalization for a mental health reason (OR = 0.51, p = 0.0006), a hospitalization for a non-mental health reason (OR = 0.43, p = 0.0002), and an emergency room (ER) visit for a mental health reason (OR = 0.60, p = 0.008). Among patients with schizophrenia, medication side effects are highly prevalent and significantly associated with medication nonadherence. Nonadherence is significantly associated with increased healthcare resource use. Prevention, identification, and effective management of medication-induced side effects are important to maximize adherence and reduce health resource use in schizophrenia.
    Full-text · Article · Mar 2012 · BMC Psychiatry
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