Medication adherence and utilization in patients with schizophrenia or bipolar disorder receiving aripiprazole, quetiapine, or ziprasidone at hospital discharge: A retrospective cohort study

Abstract

BackgroundSchizophrenia and bipolar disorder are chronic debilitating disorders that are often treated with second-generation antipsychotic agents, such as aripiprazole, quetiapine, and ziprasidone. While patients who are hospitalized for schizophrenia and bipolar disorder often receive these agents at discharge, comparatively little information exists on subsequent patterns of pharmacotherapy.MethodsUsing a database linking hospital admission records to health insurance claims, we identified all patients hospitalized for schizophrenia (ICD-9-CM diagnosis code 295.XX) or bipolar disorder (296.0, 296.1, 296.4-296.89) between January 1, 2001 and September 30, 2008 who received aripiprazole, quetiapine, or ziprasidone at discharge. Patients not continuously enrolled for 6 months before and after hospitalization (“pre-admission” and “follow-up”, respectively) were excluded. We examined patterns of use of these agents during follow-up, including adherence with treatment (using medication possession ratios [MPRs] and cumulative medication gaps [CMGs]) and therapy switching. Analyses were undertaken separately for patients with schizophrenia and bipolar disorder, respectively.ResultsWe identified a total of 43 patients with schizophrenia, and 84 patients with bipolar disorder. During the 6-month period following hospitalization, patients with schizophrenia received an average of 101 therapy-days with the second-generation antipsychotic agent prescribed at discharge; for patients with bipolar disorder, the corresponding value was 68 therapy-days. Mean MPR at 6 months was 55.1% for schizophrenia patients, and 37.3% for those with bipolar disorder; approximately one-quarter of patients switched to another agent over this period.ConclusionsMedication compliance is poor in patients with schizophrenia or bipolar disorder who initiate treatment with aripiprazole, quetiapine, or ziprasidone at hospital discharge.

Prescribing pattern of antipsychotic medications in patients with schizophrenia in a tertiary care hospital

“…12 Until date, pharmacotherapy remains the mainstay of treatment in schizophrenia patients as they target the characteristic symptoms of the disease. 3,12,13 Currently, a wide variety of antipsychotic agents are available, so it is difficult to select a particular antipsychotic on a rational basis. Older conventional drugs are highly efficacious, but they are associated with distressing extra pyramidal side-effects such as rigidity, tremors, and tardive dyskinesia.…”

Developing a Digital Medicine System in Psychiatry

“…[1][2][3] For example, a retrospective analysis of adherence to second-generation antipsychotics at 6 months after hospital discharge reported mean medication possession ratios (MPRs) of 55.1% and 37.3% among patients with schizophrenia and bipolar disorder, respectively. 4 MPR is the ratio of the total number of days supplied with medication within the follow-up refill period to the total number of days in the follow-up. Further, a systematic review of 10 studies in schizophrenia that defined adherence as "regularly taking medications as prescribed" reported a mean rate of medication nonadherence of 41.2%.…”

Aripiprazol Versus Quetiapine in Treatment of Non-affective Acute Psychosis: A Double-Blind, Randomized - Controlled Clinical Trial

“…In another study conducted by Jin and colleagues (2013) lack of significant difference in improvement in psychopathology for all atypical antipsychotics have been indicated [9]. No difference was found in medication compliance in patients with schizophrenia or bipolar disorder, who initiate treatment with Aripiprazole, Quetiapine, or Ziprasidone [10]. Rates of efficacy failure were similar between second-generation antipsychotics groups, but switching to Aripiprazole was associated with a higher rate of treatment discontinuation according to Stroup's study [11].…”