Antipsychotic utilization trajectories three years after initiating or reinitiating treatment of schizophrenia: A state sequence analysis approach

Brodeur, Sébastien; Vanasse, Alain; Courteau, Josiane; Courteau, Mireille; Stip, Émmanuel; Fleury, Marie‐Josée; Lesage, Alain; Demers, Marie-France; Roy, Marc‐André

doi:10.1111/acps.13411

Cited by 12 publications

(9 citation statements)

References 74 publications

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“…This highlights the complexity when examining and interpreting SUDs treatment utilization patterns over time using administrative data [22]. Further research could explore other longitudinal techniques such as sequence analysis, which has been recently used to study care trajectories among other health conditions [73–77]. Although very useful, governmental administrative datasets usually hide several services provided to those with SUDs, like peer‐group support or harm reduction initiatives, which constitute an important part of their care trajectories and related outcomes.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile

Bórquez,

Cerdá,

González‐Santa Cruz

et al. 2024

Addiction

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Background and aimsLongitudinal studies have revealed that substance use treatment use is often recurrent among patients; the longitudinal patterns and characteristics of those treatment trajectories have received less attention, particularly in the global south. This study aimed to disentangle heterogeneity in treatment use among adult patients in Chile by identifying distinct treatment trajectory groups and factors associated with them.DesignNational‐level registry‐based retrospective cohort.Setting and participantsAdults admitted to publicly funded substance use disorder treatment programs in Chile from November 2009 to November 2010 and followed for 9 years (n = 6266).MeasurementsMonthly treatment use; type of treatment; ownership of the treatment center; discharge status; primary substance used; sociodemographic.FindingsA seven‐class treatment trajectory solution was chosen using latent class growth analysis. We identified three trajectory groups that did not recur and had different treatment lengths: Early discontinuation (32%), Less than a year in treatment (19.7%) and Year‐long episode, without recurrence (12.3%). We also identified a mixed trajectory group that had a long first treatment or two treatment episodes with a brief time between treatments: Long first treatment, or immediate recurrence (6.3%), and three recurrent treatment trajectory groups: Recurrent and decreasing (14.2%), Early discontinuation with recurrence (9.9%) and Recurrent after long between treatments period (5.7%). Inpatient or outpatient high intensity (vs. outpatient low intensity) at first entry increased the odds of being in the longer one‐episode groups compared with the Early discontinuation group. Women had increased odds of belonging to all the recurrent groups. Using cocaine paste (vs. alcohol) as a primary substance decreased the odds of belonging to long one‐episode groups.ConclusionsIn Chile, people in publicly funded treatment for substance use disorder show seven distinct care trajectories: three groups with different treatment lengths and no recurring episodes, a mixed group with a long first treatment or two treatment episodes with a short between‐treatment‐episodes period and three recurrent treatment groups.

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Section: Discussionmentioning

confidence: 99%

Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile

Bórquez,

Cerdá,

González‐Santa Cruz

et al. 2024

Addiction

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“…Our cohort is also sizeable, containing 287 individuals, which is more than previous cohorts (Brodeur et al. , 2022 ; Howes et al. , 2012 ; Sharma et al.…”

Section: Discussionmentioning

confidence: 99%

“…Brodeur et al. ( 2022 ) used the same methodology to study patterns of the continuation and discontinuation of antipsychotics. They also demonstrated sequence analysis is valid as an adjunct to more traditional statistical methods and complementary to the latter (as in this study).…”

Section: Discussionmentioning

confidence: 99%

Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data

Laforgue,

Istvan,

Chaslerie

et al. 2023

Epidemiol Psychiatr Sci

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Aims Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and to characterize clusters of treatment trajectories. Methods Using the French National Health Insurance database, a historical cohort study of the population in an area in western France was performed. The data from all new users of clozapine with a diagnosis of schizophrenia or schizoaffective disorder in the period of 2017–2018 were evaluated. All outpatient reimbursements for antipsychotics during the 36 months before clozapine initiation were analysed. Successive reimbursements for identical treatments were grouped into treatment trials (TTs), and different trajectories were clustered using a state sequence analysis. Results The results showed 1191 TTs for 287 individuals. The mean number of TTs per individual was 3.2. Risperidone, aripiprazole and haloperidol were the main treatments delivered. The frequencies of antipsychotics used differed between monotherapies and combination therapies. A three-cluster typology was identified: one cluster (n = 133) of ‘less treated’ younger individuals with fewer TTs and shorter TT durations; a second cluster (n = 53) of ‘more treated’ individuals with higher numbers of TTs and combinations of antipsychotics; and a third cluster (n = 103) of ‘treatment-stable’ older individuals with longer TT durations. Conclusions The results indicate that the median number of TTs during the 36 months before clozapine prescription was higher than the two recommended. The different trajectories were associated with individual characteristics and treatment differences, suggesting that additional studies of clinical parameters are needed to understand barriers to clozapine prescription.

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“…It is a relatively new methodology to healthcare, but a number of studies in the last few years have used SSA. These studies fall into two primary types; those which examine temporal data such as patterns of drug adherence [ 8 , 9 ] or mortality following illness [ 10 ]; and others which study trajectories of care (for example appointment sequences and hospital stays) which are examined in the following paragraph.…”

Section: Introductionmentioning

confidence: 99%

Discovering patterns in outpatient neurology appointments using state sequence analysis

Biggin,

Ashcroft,

Howcroft

et al. 2023

BMC Health Serv Res

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Background Outpatient services in the UK, and in particular outpatient neurology services, are under considerable pressure with an ever-increasing gap between capacity and demand. To improve services, we first need to understand the current situation. This study aims to explore the patterns of appointment type seen in outpatient neurology, in order to identify potential opportunities for change. Methods We use State Sequence Analysis (SSA) on routinely collected data from a single neurology outpatient clinic. SSA is an exploratory methodology which allows patterns within sequences of appointments to be discovered. We analyse sequences of appointments for the 18 months following a new appointment. Using SSA we create groups of similar appointment sequence patterns, and then analyse these clusters to determine if there are particular sequences common to different diagnostic categories. Results Of 1315 patients 887 patients had only one appointment. Among the 428 patients who had more than one appointment a 6 monthly cycle of appointments was apparent. SSA revealed that there were 11 distinct clusters of appointment sequence patterns. Further analysis showed that there are 3 diagnosis categories which have significant influence over which cluster a patient falls into: seizure/epilepsy, movement disorders, and headache. Conclusions Neurology outpatient appointment sequences show great diversity, but there are some patterns which are common to specific diagnostic categories. Information about these common patterns could be used to inform the structure of future outpatient appointments.

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Antipsychotic utilization trajectories three years after initiating or reinitiating treatment of schizophrenia: A state sequence analysis approach

Cited by 12 publications

References 74 publications

Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile

Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile

Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data

Discovering patterns in outpatient neurology appointments using state sequence analysis

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