Patients with schizophrenia who fail to take their medicines as prescribed are over one-and-a-half times as likely to be rehospitalised and use in-patient services as patients who stick to their medication regimen. Non-adherence predicted an excess annual cost per patient of £5000 for total service use.
A new study published in the June issue of the British Journal of Psychiatry set out to assess the relative impact of non-adherence to antipsychotic medication, and other factors associated with resource use and costs, incurred by people with schizophrenia.
Secondary analyses were made of data from a 1994 survey of psychiatric illness among adults living in institutions in the UK. These comprised residential accommodation, NHS accommodation, private hospitals, homes and clinics, and unregistered accommodation.
All patients who, at the time of the survey, reported that they had been prescribed antipsychotic medication were included in the analysis.
The assessment of non-adherence to medication in the study was based on self-report by survey respondents. No distinction was made between those who deliberately did not take their medication and those who forgot to take it.
At the time of the survey 658 patients were taking antipsychotic medication. The rate of reported non-adherence was lower among patients resident in hospital (11.2%) than among patients in other types of institutions (21.2%).
These percentages are likely to be underestimates, because they do not measure non-adherence of which the patient is unaware, and do not address the problem of deliberate misreporting.
After taking account of mental health needs and other personal characteristics, patients from ethnic minorities were two-and-a-half times as likely to have used in-patient services. Patients living in a residential care home, group home or hostel were over one-and-a-half times as likely to report use of in-patient services compared with hospital residents, as were patients reporting non-adherence as compared with those reporting adherence, and those who had been taking medication for less than two years compared with those taking medication for two or more years.
Non-White patients reported greater in-patient service costs than White patients, and are predicted to incur costs of approximately £7000 more per annum than White patients.
Non-White patients were, however, significantly less likely that Whites to use external services. Patients who were non-adherent, or who had been taking medication for two or more years, were in each case over two-and-a-half times more likely to use external services compared with patients who were adherent and those who had been taking medication for less than two years.
The average total cost of all services was £33,795 per annum, with hospital residents costing significantly more than residents in other institutions.
Non-adherent patients incurred higher costs than those who adhered, and those taking medication for two or more years incurred higher costs than those taking medication for less than two years. Non-adherence is one of the most significant factors in increasing external service costs, by a factor of almost three.
Non-adherence predicted an excess annual cost per patient of approximately £2500 for in-patient services, and over £5000 for total service use. Further important factors are patient needs and the ability of the system to address them.
The authors of the study conclude that interventions that improve adherence, including psychosocial therapies and better-tolerated medication, should be encouraged, as they are likely to reduce service use costs.
Services for patients with schizophrenia should be designed to meet individual needs, including those of people from ethnic minorities.
For further information or a press copy of the full article, contact Deborah Hart or Thomas Kennedy in the External Affairs Department. Tel: 020 7235 2351 exts. 127 or 154. E-mail: [email protected].