Medication Adherence Reduces Hospital Visits in Schizophrenia

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More patients with schizophrenia utilized ED services for medical conditions vs psychiatric conditions.
More patients with schizophrenia utilized ED services for medical conditions vs psychiatric conditions.

Antipsychotic medication adherence is important to reducing the number of emergency department visits in patients diagnosed with schizophrenia, according to a study recently published in Schizophrenia Research.

This retrospective study followed eligible Medicaid patients (N=7851) to monitor medication usage, based on medication possession ratios, and hospital visits, based on Medicaid claims. The medication possession ratio was calculated by the number of days the prescription lasted, the number of times the prescription was filled, and divided by the number of days of the study. The Medicaid claims were classified into psychiatric and medical visits and then grouped into varying descriptive categories.

Researchers classified medication adherence into 5 cohorts, ranging from fully adherent to non-adherent. Patients who were partially adherent or and non-adherent had a much higher rate of medically related hospital visits, with the lowest level of adherence being more than 2 times more likely to have a medically related emergency department visit. Injuries and poisonings were the most common cause of the hospital visits (16%), followed by ill-defined symptoms and conditions (13.5%), and then musculoskeletal and connective tissue disorders (11.4%). One limitation of this study is the way the hospitals coded the visits. Many of these complaints could stem from uncontrolled psychiatric conditions, poor self-care, and inadequate treatment of chronic illnesses, which are all prevalent in psychiatric conditions. Ongoing research is needed to analyze these relationships further.

In conclusion, the researchers commented that the “majority of [emergency department] utilization among patients with schizophrenia [was] categorized as medical rather than psychiatric, and that partial and non-adherence to antipsychotics are associated with increased [emergency department] utilization for medical conditions, but not necessarily psychiatric conditions.”

Reference 

Hardy M, Jackson C, Byrne J. Antipsychotic adherence and emergency department utilization among patients with schizophrenia [published online June 10, 2018]. Schizophr Res. doi: 10.1016/j.schres.2018.06.006

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