Health Economics and Outcomes Management, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA.
Health Economics and Outcomes Research, OPTUM, Eden Prairie, MN, USA.
Curr Med Res Opin. 2021 Oct;37(10):1799-1809. doi: 10.1080/03007995.2021.1943341. Epub 2021 Jul 23.
Serious mental illnesses (SMIs), including schizophrenia, bipolar disorder, and major depressive disorder (MDD), are often treated with antipsychotic medications. Unfortunately, medication non-adherence is widespread and is associated with serious adverse outcomes. However, little real-world data are available describing adherence, compliance, or other medication-taking-related discussions between providers and patients. This study described these communications in ambulatory care.
Commercially insured patients having acute (emergency or inpatient) behavioral health (BH) events were included by specific criteria: age 18-65 years; diagnoses of schizophrenia, bipolar disorder, or MDD; continuous health insurance coverage 6 months before to 12 months after the first claim (index) date during 01/01/2014‒12/31/2015; and prescribed antipsychotic medication. Medical charts were abstracted for ambulatory visits with a BH diagnosis through 12 months after the acute event, describing any treatment compliance discussions that occurred. BH-related healthcare utilization and costs were measured insurance claims. Results were analyzed by observation of an antipsychotic medication taking-related (i.e. compliance or adherence) discussion at the initial abstracted visit.
Ninety patients were included: 62% female, mean age 41 years. Only 58% had antipsychotic compliance discussions during the first abstracted ambulatory visit. A total of 680 BH-related visits were abstracted for the 90 patients. Providers frequently discussed any psychotropic medication use (97% of all visits abstracted); however, discussion of compliance with BH talk therapies was less common (49% of visits among patients with a first visit antipsychotic discussion and 23% without, < .001). Follow-up BH-related healthcare utilization and costs were not significantly different by cohort. Patients with ≥2 compliance discussions had a significantly lower risk of follow-up acute events, which are the costliest components of healthcare for SMI ( = .023).
Increasing the frequency of antipsychotic treatment-related adherence/compliance discussions may represent an opportunity to improve the quality of care for these vulnerable patients and reduce the overall economic burden associated with the treatment of SMI diagnosis.
严重精神疾病（SMI），包括精神分裂症、双相情感障碍和重性抑郁障碍（MDD），常采用抗精神病药物治疗。然而，药物依从性差的情况普遍存在，并且与严重不良后果有关。但是，很少有真实世界的数据描述提供者和患者之间关于药物依从性、合规性或其他与药物使用相关的讨论。本研究描述了在门诊护理中的这些交流。
符合以下特定标准的商业保险患者纳入急性（急诊或住院）行为健康（BH）事件的研究：年龄 18-65 岁；诊断为精神分裂症、双相情感障碍或 MDD；在 2014 年 1 月 1 日至 2015 年 12 月 31 日期间，在第一个索赔（索引）日期前 6 个月至后 12 个月内连续医疗保险覆盖；并开具抗精神病药物。在急性事件后 12 个月内，从医疗记录中提取与 BH 诊断相关的门诊就诊，描述任何发生的治疗依从性讨论。通过保险索赔测量 BH 相关的医疗保健使用和成本。结果通过观察初始提取的就诊时与抗精神病药物服用相关的（即依从性或依从性）讨论来分析。
共纳入 90 例患者：62%为女性，平均年龄为 41 岁。只有 58%的患者在第一次门诊就诊时进行了抗精神病药物依从性讨论。为 90 名患者共提取了 680 次 BH 相关就诊。医生经常讨论任何精神药物的使用（所有提取的就诊记录的 97%）；然而，与 BH 谈话疗法的依从性讨论却不常见（在进行第一次抗精神病药物讨论的患者中，49%的就诊记录中讨论了依从性，而在未进行讨论的患者中，23%的就诊记录中讨论了依从性， < .001）。根据队列，BH 相关的后续医疗保健使用和成本没有显著差异。有≥2 次依从性讨论的患者后续发生急性事件的风险显著降低，而急性事件是 SMI 治疗最昂贵的部分（ = .023）。
增加抗精神病药物治疗相关的依从性/依从性讨论的频率可能是改善这些脆弱患者护理质量和降低与 SMI 诊断相关治疗整体经济负担的机会。
