Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
Analysis Group, Inc, Montréal, Canada.
Curr Med Res Opin. 2023 Aug;39(8):1157-1166. doi: 10.1080/03007995.2023.2237833. Epub 2023 Jul 28.
Maintaining continuity of care after schizophrenia-related hospitalization is challenging for patients and healthcare providers and systems. Prior evidence suggests that second-generation long-acting injectable antipsychotics (SGLAIs) may reduce the risk of treatment nonadherence and readmission versus oral atypical antipsychotics (OAAs). Therefore, quality measures were compared between patients initiated on SGLAIs and OAAs in the United States.
Adults newly initiated on an SGLAI or OAA during a schizophrenia-related inpatient stay were identified in HealthVerity databases (01/2015-12/2020); the index date was the hospital discharge date. Patients had continuous health insurance coverage for pharmacy and medical services for 6 months pre-admission and post-discharge from the inpatient stay and ≥1 pharmacy or medical claim (i.e. treatment as indicated by the observed insurance claims) for an antipsychotic other than the index SGLAI or OAA in the 6 months pre-admission. Antipsychotic use and adherence, and schizophrenia-related readmissions and outpatient visits were compared during the 6-month period post-discharge. Characteristics between cohorts were balanced using inverse probability weights.
Post-discharge, only 36.9% and 40.7% of weighted SGLAI ( = 466) and OAA ( = 517) patients had ≥1 pharmacy or medical claim for the antipsychotic initiated during the inpatient stay, among whom SGLAI patients were 4.4 times more likely to be adherent to that antipsychotic compared to OAA patients ( < .001). Additionally, SGLAI patients were 2.3 and 3.0 times more likely to have a pharmacy or medical claim for and be adherent to any antipsychotic relative to OAA patients (including index antipsychotic; all < .001). Within 7 and 30 days post-discharge, 1.7% and 13.0% of SGLAI patients and 4.1% and 12.6% of OAA patients had a readmission. Further, SGLAI patients were 51% more likely to have an outpatient visit compared to OAA patients ( = .044).
Less than half of patients initiated on antipsychotics during a schizophrenia-related inpatient stay continued the same treatment post-discharge. However, SGLAI patients were more likely to be adherent to the initiated antipsychotic and to have an outpatient visit, which may suggest improved continuity of care post-discharge relative to OAA patients.
对于精神分裂症相关住院患者及其医疗服务提供者和系统来说，保持治疗的连续性具有挑战性。先前的证据表明，第二代长效注射抗精神病药物（SGLAIs）与口服非典型抗精神病药物（OAAs）相比，可能降低治疗不依从和再入院的风险。因此，在美国对接受 SGLAIs 和 OAAs 治疗的患者进行了质量指标比较。
在 HealthVerity 数据库中（2015 年 1 月至 2020 年 12 月）确定了因精神分裂症相关住院而首次接受 SGLAI 或 OAA 治疗的成年人；索引日期为出院日期。患者在入院前 6 个月和出院后 6 个月内持续享受医疗保险覆盖的药房和医疗服务，并且在入院前 6 个月内，除索引 SGLAI 或 OAA 之外，有≥1 次药房或医疗服务的抗精神病药物报销（即观察到的保险报销所表明的治疗）。在出院后 6 个月内比较了抗精神病药物的使用和依从性，以及精神分裂症相关的再入院和门诊就诊情况。使用逆概率权重平衡了队列之间的特征。
出院后，仅 36.9%和 40.7%的加权 SGLAI（ = 466）和 OAA（ = 517）患者在住院期间至少有 1 次药房或医疗服务的抗精神病药物报销，其中 SGLAI 患者的依从性比 OAA 患者高 4.4 倍（ < .001）。此外，SGLAI 患者使用任何抗精神病药物的药房或医疗服务报销和依从性比 OAA 患者高 2.3 倍和 3.0 倍（包括索引抗精神病药物；均< .001）。在出院后 7 天和 30 天内，SGLAI 患者中有 1.7%和 13.0%，OAA 患者中有 4.1%和 12.6%再次入院。此外，与 OAA 患者相比，SGLAI 患者门诊就诊的可能性高 51%（ = .044）。
不到一半的因精神分裂症相关住院而接受抗精神病药物治疗的患者在出院后继续接受相同的治疗。然而，SGLAI 患者更有可能坚持使用初始抗精神病药物，并进行门诊就诊，这可能表明与 OAA 患者相比，SGLAI 患者出院后的治疗连续性得到了改善。
