Nonadherence, switching, stopping antipsychotics linked to more acute care utilization

For individuals prescribed antipsychotic medication, nonadherence, along with switching and stopping medication, was associated with increases in acute care utilization, according to a study published in BMC Psychiatry.

“Across the globe, more than 65 million people are living with schizophrenia or bipolar disorders,” Anthony J. Perkins, of the department of biostatistics and health data science at Indiana University School of Medicine, and colleagues wrote. “Approximately 56% of patients living with schizophrenia and 44% of those living with bipolar are nonadherent to their antipsychotics.”

As noncompliance commonly leads to adverse outcomes in these populations, Perkins and colleagues sought to examine patterns of antipsychotic medication use and subsequent impact on utilization of acute medical care.

They searched electronic health record data to initially identify 6,854 individuals aged 18 years and older who recorded at least one 60-day interval of continuous use of antipsychotic medication between 2006 and 2018. Analysis ultimately included 577 individuals with schizophrenia, 795 with bipolar disorder and 618 who were prescribed antipsychotics but lacked a diagnosis of either illness.

Researchers examined three variables regarding exposure to antipsychotics in the study population: proportion of days covered (PDC) for treatment adherence, switching antipsychotic medication to a different prescription and medication stoppage measure by either lack of an antipsychotic order or EHR fill data after the date when resupply was necessary. Outcomes included frequency of inpatient and ED visits up to 12 months after treatment initiation, as well as weight gain. Data was examined through Chi-square, logistic regression and sensitivity analyses.

Results showed that 53.6% of those with schizophrenia, 52.4% of those with bipolar disorder and 50.3% of those without either diagnosis demonstrated adherence to their medication. Among those with a diagnosis of schizophrenia, 22.5% switched medications, and 15.1% stopped altogether. Switching and stopping occurred in 15.8% and 15.1% of individuals with bipolar disorder and 7.4% and 20.1% of those without either illness, respectively. Researchers found that nonadherence along with switching and stopping medication use all carried associations with an increase of acute care utilization after adjusting for baseline demographics. Further associations with past acute care utilization and comorbidity were also found in the nonadherent or switching/stopping populations.

“Our results provide further evidence of the association between noncontinuous antipsychotic medication use and increased acute care utilization,” Perkins and colleagues wrote.