Duke University School of Medicine, DUMC 3878, Durham, NC 27710, United States; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Dr., Chapel Hill, NC 27599, United States.
Community Care of North Carolina, 2300 Rexwoods Drive, Suite 100, Raleigh, NC 27607, United States; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 333 South Columbia Street, Chapel Hill, NC 27514, United States.
Schizophr Res. 2018 Nov;201:347-351. doi: 10.1016/j.schres.2018.06.006. Epub 2018 Jun 10.
This retrospective cohort study evaluated the relationship between antipsychotic medication adherence and emergency department (ED) utilization for 7851 Medicaid patients with schizophrenia enrolled in Community Care of North Carolina (CCNC). Claims and pharmacy data from January to December 2015 were collected. Medication adherence was approximated using the medication possession ratio (MPR). Negative binomial regressions estimated the effect of antipsychotic adherence on rates of medical and psychiatric ED visits. The results demonstrated a statistically significant negative relationship between antipsychotic adherence and medical ED utilization. Non- and partially adherent patients (MPR < 0.80) had 1.61 times the rate of medical ED visits as fully adherent patients (MPR ≥ 0.80) (95% CI: 1.50-1.74, p-value < 0.001). The relationship between adherence and psychiatric utilization was small and not statistically significant. The most common diagnostic categories of ED visits were injuries and poisonings (16%), ill-defined symptoms (14%), and musculoskeletal conditions (12%). This study demonstrates a clear association between antipsychotic adherence and medical ED utilization, suggesting an important link between psychiatric management and medical utilization in patients with schizophrenia.
这项回顾性队列研究评估了北卡罗来纳社区护理中心（CCNC）7851 名使用医疗补助计划（Medicaid）的精神分裂症患者的抗精神病药物依从性与急诊就诊率之间的关系。研究收集了 2015 年 1 月至 12 月期间的索赔和药房数据。药物依从性通过药物持有率（MPR）来估算。使用负二项回归估计抗精神病药物依从性对医疗和精神科急诊就诊率的影响。结果表明，抗精神病药物依从性与医疗急诊就诊率之间存在统计学上显著的负相关关系。非依从和部分依从（MPR<0.80）患者的急诊就诊率是完全依从（MPR≥0.80）患者的 1.61 倍（95%CI：1.50-1.74，p 值<0.001）。依从性与精神科就诊率之间的关系较小，且无统计学意义。急诊就诊最常见的诊断类别是伤害和中毒（16%）、症状未明（14%）和肌肉骨骼疾病（12%）。这项研究表明，抗精神病药物依从性与医疗急诊就诊率之间存在明确关联，这表明精神科治疗与精神分裂症患者的医疗利用率之间存在重要联系。
