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Medication Adherence Rates Low Among Patients with Serious Mental Illness

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Avalere research recently published in ClinicoEconomics and Outcomes Research compared patient characteristics and real-world outcomes in 2 distinct high-risk cohorts of patients with serious mental illness (SMI), including patients with a hospitalization related to SMI (recently discharged) and patients newly diagnosed with SMI (early episode). The research included 51,705 patients with bipolar disorder, major depressive disorder, and schizophrenia.

As of 2017, an estimated 11.2 million (4.5%) of American adults had a diagnosis of SMI. It is also projected that the illness costs $193 billion per year in lost earnings as well as more than $100 billion per year in health care costs, representing a significant economic burden. Non-adherence to SMI treatment is associated with poor outcomes, including psychiatric hospitalization, relapse, negative social outcomes (e.g., arrest, job loss), and increased risk of attempted suicide.

The findings of “Antipsychotic Medication Adherence and Healthcare Services Utilization in Two Cohorts of Patients with Serious Mental Illness” include:

  • More than half of individuals with SMI were over the age of 46 and more than 60% were female
  • Overall adherence to psychiatric medications for recently discharged patients was 52.5%, and for early episode patients it was 16.1%
  • Over 50% of those recently discharged and 100% of early episode patients switched medications at least once annually
  • Nineteen percent of recently discharged patients changed medications at least once annually compared to 14% of early episode patients
  • The recently discharged patients (generally older and sicker) had higher psychiatric-related utilization and higher annual costs
  • Women with SMI were more likely to have an emergency department and primary care provider visit, but less likely to be hospitalized

Key Takeaway: Efforts to manage SMI are confounded by patient heterogeneity and low adherence to treatment. By better understanding which patients are at highest risk for specific adverse outcomes, clinicians can target interventions more appropriately to reduce the significant burden of SMI.

Felicia Forma of Otsuka Pharmaceutical also contributed to this research.

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