Impact of treatment-related discussions on healthcare resource use and costs among patients with severe mental illness

Abstract

Objective: Serious mental illnesses (SMIs), including schizophrenia, bipolar disorder, and major depressive disorder (MDD), are often treated with antipsychotic medications. Unfortunately, medication nonadherence is widespread and is associated with serious adverse outcomes. However, little real-world data are available describing adherence, compliance, or other medication-taking-related discussions between providers and patients. This study described these communications in ambulatory care. Methods: Commercially insured patients having acute (emergency or inpatient) behavioral health (BH) events were included by specific criteria: age 18-65 years; diagnoses of schizophrenia, bipolar disorder, or MDD; continuous health insurance coverage 6 months before to 12 months after the first claim (index) date during 01/01/2014-12/31/2015; and prescribed antipsychotic medication. Medical charts were abstracted for ambulatory visits with a BH diagnosis through 12 months after the acute event, describing any treatment compliance discussions that occurred. BH-related healthcare utilization and costs were measured via insurance claims. Results were analyzed by observation of an antipsychotic medication taking-related (i.e. compliance or adherence) discussion at the initial abstracted visit. Results: Ninety patients were included: 62% female, mean age 41 years. Only 58% had antipsychotic compliance discussions during the first abstracted ambulatory visit. A total of 680 BH-related visits were abstracted for the 90 patients. Providers frequently discussed any psychotropic medication use (97% of all visits abstracted); however, discussion of compliance with BH talk therapies was less common (49% of visits among patients with a first visit antipsychotic discussion and 23% without, p < .001). Follow-up BH-related healthcare utilization and costs were not significantly different by cohort. Patients with !2 compliance discussions had a significantly lower risk of follow-up acute events, which are the costliest components of healthcare for SMI (p ¼ .023). Conclusion:Increasing the frequency of antipsychotic treatment-related adherence/compliance discussions may represent an opportunity to improve the quality of care for these vulnerable patients and reduce the overall economic burden associated with the treatment of SMI diagnosis.

Healthcare Provider Engagement with a Novel Dashboard for Tracking Medication Ingestion: Impact on Treatment Decisions and Clinical Assessments for Adults with Schizophrenia

“… 52 This is notable given a 2021 study by Forma et al, in which patients who had ≥2 discussions about medication adherence with their providers had a 76% reduced risk of an acute psychiatric event during the following year. 60 A recent study by Xia et al using a person-centered adherence counseling intervention among patients with SMI found that the intervention increased adherence 30 days postdischarge by 33% and reduced the likelihood of rehospitalization (odds ratio: 0.32; 95% CI: 0.11–0.93 [p=0.037]) compared with patients given treatment as usual. 61 A meta-analysis of six studies of adherence therapy given to patients with schizophrenia spectrum disorders found a significant improvement in psychiatric symptoms compared with treatment as usual.…”

Building and Validation of an Acute Event Prediction Model for Severe Mental Disorders

“…SMD patients cannot fully understand their own health and the objective reality or handle their own affairs of psychiatric disorders, 1 including schizophrenia, bipolar disorder and major depression disorder. 2 , 3 They usually use antipsychotic medication. Taking drugs is common, which however is associated with serious adverse consequences and leads to disability and premature death to a great extent.…”