Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA.
Merck & Co., Inc, Rahway, NJ, USA.
BMC Psychiatry. 2023 Jan 24;23(1):64. doi: 10.1186/s12888-023-04558-6.
Non-adherence to psychotropic medications is common in schizophrenia and bipolar disorders (BDs) leading to adverse outcomes. We examined patterns of antipsychotic use in schizophrenia and BD and their impact on subsequent acute care utilization.
We used electronic health record (EHR) data of 577 individuals with schizophrenia, 795 with BD, and 618 using antipsychotics without a diagnosis of either illness at two large health systems. We structured three antipsychotics exposure variables: the proportion of days covered (PDC) to measure adherence; medication switch as a new antipsychotic prescription that was different than the initial antipsychotic; and medication stoppage as the lack of an antipsychotic order or fill data in the EHR after the date when the previous supply would have been depleted. Outcome measures included the frequency of inpatient and emergency department (ED) visits up to 12 months after treatment initiation.
Approximately half of the study population were adherent to their antipsychotic medication (a PDC ≥ 0.80): 53.6% of those with schizophrenia, 52.4% of those with BD, and 50.3% of those without either diagnosis. Among schizophrenia patients, 22.5% switched medications and 15.1% stopped therapy. Switching and stopping occurred in 15.8% and 15.1% of BD patients and 7.4% and 20.1% of those without either diagnosis, respectively. Across the three cohorts, non-adherence, switching, and stopping therapy were all associated with increased acute care utilization, even after adjusting for baseline demographics, health insurance, past acute care utilization, and comorbidity.
Non-continuous antipsychotic use is common and associated with high acute care utilization.
精神分裂症和双相情感障碍（BD）患者经常不遵医嘱服用精神类药物，导致不良后果。我们研究了精神分裂症和 BD 患者的抗精神病药物使用模式及其对后续急性护理利用的影响。
我们使用了两个大型医疗系统的 577 名精神分裂症患者、795 名 BD 患者和 618 名未被诊断为这两种疾病但使用抗精神病药物的患者的电子健康记录（EHR）数据。我们构建了三个抗精神病药物暴露变量：以衡量依从性的比例天数覆盖（PDC）；药物转换是指新的抗精神病药物处方与初始抗精神病药物不同；药物停药是指在之前的药物供应耗尽日期之后，EHR 中缺乏抗精神病药物医嘱或配药数据。结果测量包括治疗开始后 12 个月内住院和急诊部（ED）就诊的频率。
研究人群中约有一半患者（PDC≥0.80）对抗精神病药物的依从性较好：精神分裂症患者为 53.6%，BD 患者为 52.4%，无这两种诊断的患者为 50.3%。在精神分裂症患者中，22.5%的患者更换了药物，15.1%的患者停止了治疗。BD 患者中分别有 15.8%和 15.1%的患者发生了药物转换和停药，无这两种诊断的患者中分别有 7.4%和 20.1%的患者发生了药物转换和停药。在这三个队列中，即使在调整了基线人口统计学、健康保险、过去急性护理利用和合并症等因素后，不依从、药物转换和停药都与急性护理利用的增加有关。
非连续使用抗精神病药物很常见，且与高急性护理利用率相关。
