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Published Online: 1 August 2017

Adherence to Antipsychotic Therapy: Association With Hospitalization and Medicare Spending Among Part D Enrollees With Schizophrenia

Pamela Roberto, Ph.D., M.P.P. [email protected], Nicole Brandt, Pharm.D., M.B.A., Eberechukwu Onukwugha, Ph.D., M.S., Eleanor Perfetto, Ph.D., M.S., Christopher Powers, Pharm.D., and Bruce Stuart, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 68, Number 11
https://doi.org/10.1176/appi.ps.201600434
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Abstract

Objective:

This study examined relationships among antipsychotic adherence, hospitalization, and hospital expenditures in a sample of 13,861 Medicare Part D enrollees with schizophrenia.

Methods:

Utilization and expenditure data were obtained from the Centers for Medicare and Medicaid Services Chronic Conditions Warehouse for 2011 and 2012. Adherence was measured with the proportion of days covered and stratified into four categories. Probit regressions and two-part generalized linear models were used to examine relationships between adherence in year 1 and outcomes in year 2.

Results:

Adherence to antipsychotic therapy was associated with a significantly lower probability of psychiatric hospitalization and significantly lower psychiatric hospital expenditures, with the largest effect sizes observed for the most highly adherent beneficiaries. There was no relationship between antipsychotic adherence and hospitalizations or expenditures for nonpsychiatric conditions.

Conclusions:

Adherence to antipsychotics among Medicare Part D enrollees with schizophrenia was associated with significantly lower probability of psychiatric hospitalization and lower hospital expenditures.

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Information & Authors

Information

Published In

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Cover: Still Life of Fruit, anonymous, circa 1865. Gift of Edgar William and Bernice Chrysler Garbisch, National Gallery of Art, Washington, D.C.

Psychiatric Services
Volume 68 • Number 11 • November 01, 2017
Pages: 1185 - 1188
PubMed: 28760097

History

Received: 20 September 2016
Revision received: 26 March 2017
Revision received: 22 April 2017
Accepted: 31 May 2017
Published online: 1 August 2017
Published in print: November 01, 2017

Keywords

  1. Adherence
  2. Antipsychotics
  3. Outcome studies
  4. Schizophrenia

Authors

Details

Pamela Roberto, Ph.D., M.P.P. [email protected]
Dr. Roberto, Dr. Onukwugha, Dr. Perfetto, and Dr. Stuart are with the Department of Pharmaceutical Health Services Research and Dr. Brandt is with the Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Dr. Roberto is also with the Department of Policy and Research, Pharmaceutical Research and Manufacturers of America, Washington, D.C. Dr. Perfetto is also with the National Health Council, Washington, D.C. Dr. Powers is with the Office of Information Products and Data Analytics, Centers for Medicare and Medicaid Services, Baltimore.
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Nicole Brandt, Pharm.D., M.B.A.
Dr. Roberto, Dr. Onukwugha, Dr. Perfetto, and Dr. Stuart are with the Department of Pharmaceutical Health Services Research and Dr. Brandt is with the Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Dr. Roberto is also with the Department of Policy and Research, Pharmaceutical Research and Manufacturers of America, Washington, D.C. Dr. Perfetto is also with the National Health Council, Washington, D.C. Dr. Powers is with the Office of Information Products and Data Analytics, Centers for Medicare and Medicaid Services, Baltimore.
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Eberechukwu Onukwugha, Ph.D., M.S.
Dr. Roberto, Dr. Onukwugha, Dr. Perfetto, and Dr. Stuart are with the Department of Pharmaceutical Health Services Research and Dr. Brandt is with the Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Dr. Roberto is also with the Department of Policy and Research, Pharmaceutical Research and Manufacturers of America, Washington, D.C. Dr. Perfetto is also with the National Health Council, Washington, D.C. Dr. Powers is with the Office of Information Products and Data Analytics, Centers for Medicare and Medicaid Services, Baltimore.
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Eleanor Perfetto, Ph.D., M.S.
Dr. Roberto, Dr. Onukwugha, Dr. Perfetto, and Dr. Stuart are with the Department of Pharmaceutical Health Services Research and Dr. Brandt is with the Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Dr. Roberto is also with the Department of Policy and Research, Pharmaceutical Research and Manufacturers of America, Washington, D.C. Dr. Perfetto is also with the National Health Council, Washington, D.C. Dr. Powers is with the Office of Information Products and Data Analytics, Centers for Medicare and Medicaid Services, Baltimore.
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Christopher Powers, Pharm.D.
Dr. Roberto, Dr. Onukwugha, Dr. Perfetto, and Dr. Stuart are with the Department of Pharmaceutical Health Services Research and Dr. Brandt is with the Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Dr. Roberto is also with the Department of Policy and Research, Pharmaceutical Research and Manufacturers of America, Washington, D.C. Dr. Perfetto is also with the National Health Council, Washington, D.C. Dr. Powers is with the Office of Information Products and Data Analytics, Centers for Medicare and Medicaid Services, Baltimore.
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Bruce Stuart, Ph.D.
Dr. Roberto, Dr. Onukwugha, Dr. Perfetto, and Dr. Stuart are with the Department of Pharmaceutical Health Services Research and Dr. Brandt is with the Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Dr. Roberto is also with the Department of Policy and Research, Pharmaceutical Research and Manufacturers of America, Washington, D.C. Dr. Perfetto is also with the National Health Council, Washington, D.C. Dr. Powers is with the Office of Information Products and Data Analytics, Centers for Medicare and Medicaid Services, Baltimore.
View all articles by this author

Notes

Send correspondence to Dr. Roberto (e-mail: [email protected]).

Competing Interests

Dr. Onukwugha has received research grants from Pfizer, Inc., Bayer Healthcare Pharmaceuticals, and Takeda Pharmaceuticals. Dr. Brandt is Board Chairman of the American Society of Consultant Pharmacists; a member of the Pharmacy and Therapeutics Committee, CVS Health Omnicare; and a consultant for Rand, Inc. The other authors report no financial relationships with commercial interests.

Funding Information

This is an unfunded study that was conducted as part of Dr. Roberto’s doctoral dissertation research.

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