Mental Health

Ten-day lapse in antipsychotic drug use is associated with an increased risk of hospitalization in patients with schizophrenia

Antipsychotic medications to treat schizophrenia are effective in reducing symptoms and preventing hospitalization. However, only 50-60 percent of patients treated for schizophrenia follow their medication regimen for extended periods, with only 12 percent of Medicaid-insured patients staying on their medications for a full year. Yet, failing to refill medication within even just 10 days is associated with an increased risk of hospitalization, according to a new study.

The Harvard Medical School researchers analyzed the Medicaid and Medicare claims data of 1,191 patients with schizophrenia from the Maine and New Hampshire Medicaid programs. The researchers used Medicaid pharmacy claims data to determine to what extent gaps in taking atypical antipsychotic medications, medication switching, and augmentation with additional antipsychotic drugs were related to hospitalization risk. Of the individuals whose records were studied, 552 were hospitalized over 3 years, including 371 for mental health problems and 315 for schizophrenia.

Compared with patients who continued to refill their medication, those who missed refilling their medication for as little as 10 days had a significant 54 percent increased risk of hospitalization for mental health problems and a 77 percent higher risk of hospitalization for schizophrenia. Those patients whose medication gaps were longer than 30 days were 60 percent and 49 percent more likely to be hospitalized for mental health problems and schizophrenia, respectively. Given that higher risk of hospitalization occurs within 10 days of a missed prescription refill, immediate action to increase adherence as early as possible might lower the risk of schizophrenia relapse.

The study was funded in part by the Agency for Healthcare Research and Quality for the Centers for Research and Education in Therapeutics (CERT) (HS10391). For more information on the CERTs program, go to http://www.ahrq.gov/clinic/certsovr.htm.

See "A longitudinal study of medication nonadherence and hospitalization risk in schizophrenia," by Michael R. Law, M.Sc., Stephen B. Soumerai, Sc.D., Dennis Ross-Degnan, Sc.D., and Alyce S. Adams, Ph.D., in the January 2008 Journal of Clinical Psychiatry 69(1), pp. 47-53.

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