| 1 | Curr Med Res Opin 2009 Sep 25: 2303-10 |
|---|---|
| PMID | 19635045 |
| Title | Good and poor adherence: optimal cut-point for adherence measures using administrative claims data. |
| Abstract | 确定值分界点的坚持optimally stratifies good versus poor compliers using administratively derived adherence measures, the medication possession ratio (MPR) and the proportion of days covered (PDC) using hospitalization episode as the primary outcome among Medicaid eligible persons diagnosed withschizophrenia, diabetes, hypertension, congestive heart failure (CHF), or hyperlipidemia. 这是一个阿肯色州读出的回顾性分析caid administrative claims data. Patients > or =18 years old had to have at least one ICD-9-CM code for the study diseases during the recruitment period July 2000 through April 2004 and be continuously eligible for 6 months prior and 24 months after their first prescription for the target condition. Adherence rates to disease-specific drug therapy were assessed during 1 year using MPR andPDC。MAIN OUTCOME MEASURE AND ANALYSIS SCHEME: The primary outcome measure was any-cause and disease-related hospitalization. Univariate logistic regression models were used to predict hospitalizations. The optimum adherence value was based on the adherence value that corresponded to the upper most left point of the ROC curve corresponding to the maximum specificity and sensitivity. The optimal cut-off adherence value for the MPR andPDCin predicting any-cause hospitalization varied between 0.63 and 0.89 across the five cohorts. In predicting disease-specific hospitalization across the five cohorts, the optimal cut-off adherence values ranged from 0.58 to 0.85. This study provided an initial empirical basis for selecting 0.80 as a reasonable cut-off point that stratifies adherent and non-adherent patients based on predicting subsequent hospitalization across several highly prevalent chronic diseases. This cut-off point has been widely used in previous research and our findings suggest that it may be valid in these conditions; it is based on a single outcome measure, and additional research using these methods to identify adherence thresholds using other outcome metrics such as laboratory or physiologic measures, which may be more strongly related to adherence, is warranted. |
| SCZ Keywords | schizophrenia, schizophrenic |
| 2 | Value Health 2009 Sep 12: 989-95 |
| PMID | 19402852 |
| Title | Prospective validation of eight different adherence measures for use with administrative claims data among patients with schizophrenia. |
| Abstract | 这项研究的目的是通过研究诊断为诊断为医疗补助的人之间的每种措施和住院事件之间的可变性来比较八种不同的依从性措施的预测有效性。schizophrenia关于抗精神病药单一疗法。 This study was a retrospective analysis of the Arkansas Medicaid administrative claims data. Continuously eligible adultschizophrenia（ICD-9-CM = 295。**）在2000年7月至2004年4月的招募期间确定了抗精神病药单药治疗的患者。使用文献中确定的八种不同的措施计算了1年级抗精神病药疗法的粘附率。在随访年中，使用单变量和多变量逻辑回归模型预测全因和心理健康相关的住院。 Adherence rates were computed for 3395schizophrenic平均年龄为42.9岁的患者，其中52.5％（n = 1782）为女性，52.8％（n = 1793）是白人。覆盖天的比例（PDC在预测全因和心理健康相关的住院方面，依从性的药物差距度量的连续度量均等为0.571。药物拥有率（MPR）连续多个间隔供应量供应量是第二好的措施，对于任何导致和心理健康相关的住院治疗的C统计量为0.568和0.567。多元调整后的模型具有较高的C统计数据，但提供了相同的等级顺序结果。 MPR和PDCwere among the best predictors of any-cause and mental health-related hospitalization, and are recommended as the preferred adherence measures when a single measure is sought for use with administrative claims data for patients not on polypharmacy. |
| SCZ Keywords | schizophrenia, schizophrenic |
| 3 | Value Health 2009 Sep 12: 989-95 |
| PMID | 19402852 |
| Title | Prospective validation of eight different adherence measures for use with administrative claims data among patients with schizophrenia. |
| Abstract | 这项研究的目的是通过研究诊断为诊断为医疗补助的人之间的每种措施和住院事件之间的可变性来比较八种不同的依从性措施的预测有效性。schizophrenia关于抗精神病药单一疗法。 This study was a retrospective analysis of the Arkansas Medicaid administrative claims data. Continuously eligible adultschizophrenia（ICD-9-CM = 295。**）在2000年7月至2004年4月的招募期间确定了抗精神病药单药治疗的患者。使用文献中确定的八种不同的措施计算了1年级抗精神病药疗法的粘附率。在随访年中，使用单变量和多变量逻辑回归模型预测全因和心理健康相关的住院。 Adherence rates were computed for 3395schizophrenic平均年龄为42.9岁的患者，其中52.5％（n = 1782）为女性，52.8％（n = 1793）是白人。覆盖天的比例（PDC在预测全因和心理健康相关的住院方面，依从性的药物差距度量的连续度量均等为0.571。药物拥有率（MPR）连续多个间隔供应量供应量是第二好的措施，对于任何导致和心理健康相关的住院治疗的C统计量为0.568和0.567。多元调整后的模型具有较高的C统计数据，但提供了相同的等级顺序结果。 MPR和PDCwere among the best predictors of any-cause and mental health-related hospitalization, and are recommended as the preferred adherence measures when a single measure is sought for use with administrative claims data for patients not on polypharmacy. |
| SCZ Keywords | schizophrenia, schizophrenic |
| 4 | Ann Pharmacother 2009 Jan 43: 36-44 |
| PMID | 19126828 |
| Title | Contrasting measures of adherence with simple drug use, medication switching, and therapeutic duplication. |
| Abstract | Multiple measures of adherence have been reported in the research literature and it is difficult to determine which is best, as each is nuanced. Occurrences of medication switching and polypharmacy or therapeutic duplication can substantially complicate adherence calculations when adherence to a therapeutic class is sought. To contrast the Proportion of Days Covered (PDC) adherence metric with 2 variants of the Medication Possession Ratio (MPR, truncated MPR). This study was a retrospective analysis of the North Carolina Medicaid administrative claims data from July 1999 to June 2000. Data for patients withschizophrenia(ICD-9-CM code 295.xx) who were not part of a health maintenance organization, not hospitalized, and not pregnant, taking at least one antipsychotic, were aggregated for each person into person-quarters. The numerator forPDCwas defined as the number of days one or more antipsychotics was available and the MPR numerator was defined as the total days' supply of antipsychotics; both were divided by the total days in each person-quarter. Adherence rates were estimated for subjects who used only one antipsychotic, switched medications, or had therapeutic duplication in the quarter. 最后的样本包括25200 person-quarters from 7069 individuals. For person-quarters with single antipsychotic use, adherence to antipsychotics as a class was:PDC0.607, truncated MPR 0.640, and MPR 0.695 (p < 0.001). For person-quarters with switching, the average MPR was 0.690, truncated MPR was 0.624, andPDCwas 0.562 (p < 0.001). In the presence of therapeutic duplication, thePDCwas 0.669, truncated MPR was 0.774, and MPR was 1.238 (p < 0.001). ThePDCprovides a more conservative estimate of adherence than the MPR across all types of users; however, the differences between the 2 methods are more substantial for persons switching therapy and prescribed therapeutic duplication, where MPR may overstate true adherence. ThePDC当寻求遵守一类药物的措施时，应考虑考虑，尤其是在临床情况下，通常会同时使用类中多种药物。 |
| SCZ Keywords | schizophrenia, schizophrenic |
| 5 | Community Ment Health J 2010 Jun 46: 265-72 |
| PMID | 20091226 |
| Title | Antidepressant and antipsychotic use and adherence among Medicaid youths: differences by race. |
| Abstract | The purpose of our study is to use Medicaid data to examine the relationship between race and (a) whether youth withschizophreniaor depression diagnoses receive anti-psychotic and antidepressant prescriptions and (b) adherence to anti-psychotics and antidepressants. The analysis is based on claims files from January 1, 2000 through June 30, 2001. To assess adherence, we used the Proportion of Days Covered (PDC) measure. Multivariable logistic regression was used to analyze the data. Black children withschizophreniawere significantly less likely to be adherent to anti-psychotics during a quarter than White children. White children with depression were significantly more likely to receive an antidepressant prescription and they were significantly more adherent during a quarter than Black children. Providers should make sure to investigate both youth and caregiver concerns, fears, and barriers to using these medications and work with the families to develop strategies to improve medication use among youth. |
| SCZ Keywords | schizophrenia, schizophrenic |
| 6 | Pharmacopsychiatry 2012 Jun 45: 138-45 |
| PMID | 22174026 |
| Title | Psychotropic drug treatment, clinical characteristics and cognitive processing speed in patients with schizophrenia: results from the ELAN study. |
| Abstract | Psychotropic drug combinations (PDC) are common in the treatment of patients withschizophreniabut there is little research regarding the effects ofPDCon cognition. The aim of this study was to analyse the effects of antipsychotic monotherapy and various types ofPDCon cognitive processing speed (CPS). ELAN is a 24-month multi-site prospective observational controlled trial following up 374 patients withschizophreniaunder routine treatment conditions following discharge from inpatient treatment. The propensity score method, multinomial logistic regression analyses and mixed effects regression models were used. CPS correlated significantly with PANSS and GAF scores and improved over time in the monotherapy group. Negative effects of somePDC(antipsychotics + tranquilizers/antipsychotics+at least 2 other psychopharmacological subclasses, sedative/anticholinergic drugs/high adjusted antipsychotic dose) lost significance after controlling for clinical characteristics. Indications forPDCshould be examined with care although, in the present study, effects on cognition were small. |
| SCZ Keywords | schizophrenia, schizophrenic |
| 7 | BMC Psychiatry 2013 -1 13: 246 |
| PMID | 24094241 |
| Title | Antipsychotic adherence patterns and health care utilization and costs among patients discharged after a schizophrenia-related hospitalization. |
| Abstract | 本研究的目的是评估抗精神病药物的依从性patterns and all-cause andschizophrenia-related health care utilization and costs sequentially during critical clinical periods (i.e., before and afterschizophrenia-related hospitalization) among Medicaid-enrolled patients experiencing aschizophrenia-related hospitalization. All patients aged ? 18 years with aschizophrenia-related inpatient admission were identified from the MarketScan Medicaid database (2004-2008). Adherence (proportion of days covered [PDC]）抗精神病药和schizophrenia-related and all-cause health care utilization and costs were assessed during preadmission (182- to 121-day, 120- to 61-day, and 60- to 0-day periods; overall, 6 months) and postdischarge periods (0- to 60-day, 61- to 120-day, 121- to 180-day, 181- to 240-day, 241- to 300-day, and 301- to 365-day periods; overall, 12 months). Health care utilization and costs (2010 US dollars) were compared between each adjacent 60-day follow-up period after discharge using univariate and multivariable regression analyses. No adjustment was made for multiplicity. Of the 2,541 patients withschizophrenia（平均年龄：41.2岁；男性为57％； 59％黑色）被识别出，约有89％的人“被送往家庭自我保健”。与索引住院入院之前的60至0天相比，由PDCwas observed during the 0- to 60-day period immediately following discharge (0.46 vs. 0.78, respectively). The meanPDCduring the overall 6-month preadmission period was lower than during the 6-month postdischarge period (0.53 vs. 0.69; P < 0.001). Compared with the 0- to 60-day postdischarge period,schizophrenia在61至120天期间，相关的医疗保健费用明显降低（平均：2,708美元，$ 2,102； P <0.001）；主要成本驱动因素是重新寄养（平均：$ 978 vs. $ 660; p <0.001）和药房（平均：959美元vs. $ 743; p <0.001）。在最初的60天之后，全原因和schizophrenia- 相关费用下降，在剩余的后期期间（第121-365天）保持稳定。 Although long-term (e.g., 365-day) adherence measures are important, estimating adherence over shorter intervals may clarify the course of vulnerability to risk and enable clinicians to better design adherence/risk-related interventions. The greatest risk of rehospitalization and thus greater resource utilization were observed during the initial 60-day postdischarge period. Physicians should consider tailoring management and treatment strategies to help mitigate the economic and humanistic burden for patients withschizophrenia在这段时期。 |
| SCZ Keywords | schizophrenia, schizophrenic |
| 8 | J Psychiatr Res 2013 Apr 47: 460-6 |
| PMID | 23317876 |
| Title | The incidence and all-cause mortality of pneumonia in patients with schizophrenia: a nine-year follow-up study. |
| Abstract | This study sought to estimate the incidence, all-cause mortality and relative risks for patients withschizophreniaafter a pneumonia diagnosis. 该人口是从1999年从台湾国家健康保险研究数据库（NHIRD）确定的，其中包括59,021例患者beplay苹果手机能用吗schizophreniaand 236,084 age- and sex-matched control participants withoutschizophrenia。这些参与者是从23,981,020名参与者NHIRD中随机选择的，该参与者占整个人群的96％。使用2000-2008 NIHRD，计算了肺炎的发病率和9年无肺炎生存率（ICD-9-CM代码486和507.0-507.8）。 Over nine years, 6055 (10.26%) patients withschizophreniaand 7844 (3.32%) controls had pneumonia. The pneumonia incidence density was 11.4/1000 person-years among the patients withschizophrenia, who experienced a 3.09-fold increased risk of developing pneumonia. After adjusting for other covariates, the patients withschizophreniastill experienced a 1.77-fold increased risk of developing pneumonia. Although, without adjustment, fewerschizophreniapatients than controls died after having pneumonia (2121 [35.12%] vs. 3497 [44.62%]), after adjusting for other variables, the mortality hazard ratio for patients withschizophreniawas 1.39. 在九年的随访中，患者患肺炎和全因死亡率的可能性schizophreniawas higher than that of the non-schizophreniagroup as was the mortality rate. Interestingly, the psychiatric proportion of days covered (PDC）与肺炎正相关（OR：2.51），但与死亡负相关（HR：0.72）。这些发现暗示了医源性因素和精神药物的重要性（包括其益处和副作用），并突出了未来研究的方向。 |
| SCZ Keywords | schizophrenia, schizophrenic |
| 9 | Schizophr. Res. 2014 Nov 159: 322-8 |
| PMID | 25445622 |
| Title | The risks of major osteoporotic fractures in patients with schizophrenia: a population-based 10-year follow-up study. |
| Abstract | The aim of the study is to explore the incidence and the risks associated with major osteoporotic fractures, all-cause mortality with osteoporotic fractures and the effect of the psychiatric drug exposure in patients withschizophreniaduring a 10-year follow-up period. Two nationwide cohorts were selected from the Taiwan National Health Insurance Research Database (NHIRD) consisting of 30,335 patients withschizophrenia(age ? 40 years) and 121,340 age- and sex-matched control participants withoutschizophrenia。The psychiatric proportion of days covered (PDC) is an indicator of the intensity of drug exposure in patients withschizophrenia。The incidence and risk factors of major osteoporotic fractures were calculated for both cohorts. Additionally, the patient survival rate after major osteoporotic fractures was also calculated. During a 10-year follow-up period, 1677 (5.53%)schizophreniaand 4257 (3.51%) control subjects had major osteoporotic fractures (P < 0.001). Theschizophreniapatients with aPDC> 0.1 showed a significantly higher incidence of major osteoporotic fractures than did the non-schizophreniacontrols; however, those with a psychiatricPDC? 0.1 did not. After adjustment, the psychiatricPDCwas significantly and independently associated with the risk of major osteoporotic fractures except some medical morbidities but theschizophreniadiagnosis was not. In addition, among all 5934 patients with major osteoporotic fracture, the adjusted mortality hazard ratio for psychiatricPDCwas 1.92 (95% CI = 1.63-2.26). Patients withschizophreniaare at a higher risk for major osteoporotic fractures than the general population and also have a higher mortality rate due to major osteoporotic fractures. These findings may be caused by psychiatric drug use rather thanschizophrenia, which suggests that directions can be taken in future studies. |
| SCZ Keywords | schizophrenia, schizophrenic |
| 10 | J Manag Care Spec Pharm 2014 7月20日：756-66 |
| PMID | 24967528 |
| Title | Methodological considerations in estimating adherence and persistence for a long-acting injectable medication. |
| Abstract | Measures of medication adherence and persistence are important for researchers and policymakers to assess quality of care. Lack of adherence has been associated with adverse outcomes and higher costs of care. Long-acting medication formulations, including injectable forms, have been proposed as interventions to increase adherence and in turn improve health outcomes and costs. Standard measures of adherence/persistence were developed for orally administered medications. Methods for assessing adherence/persistence of long-acting injectable dose forms are understudied. To compare the consistency between standard measures of adherence/persistence versus proposed variations that consider the data quality and injectable administration method for a long-acting injectable second-generation antipsychotic (SGA) using an orally administered SGA as the reference. Standard adherence/persistence measures were designed for oral tablet formulations, in particular accounting for accumulation of pills caused by early refills. To address this limitation and the accuracy of the days supply field for long-acting injectable SGAs in pharmacy claims, 2 alternatives are proposed. The first approach calculates days supply using the labeled dosing schedule for the given injectable. The second approach builds on the first and sets days supply to the minimum of the time between injections and the time frame according to the labeled dosing schedule. Administrative health care claims data from the Missouri Medicaid system were analyzed to compare adherence/persistence measures between formulations. Common adherence/persistence measures, including medication possession ratio (MPR) and proportion of days covered (PDC）在本研究中评估。该分析队列包括195名成年患者schizophreniawho initiated a long-acting injectable SGA (LA-SGA) and 369 patients initiating an oral SGA (O-SGA) from August 1, 2009, through April 30, 2010. Chi-squared tests, the Kruskal-Wallis test, and Kaplan-Meier curves were used to compare adherence/persistence measures between cohorts. 天数最常记录为O-SGA的30天，而LA-SGA的供应量最多28天。索赔填充之间的时间最常见于两个队列的28天。使用LA-SGA药房索赔数据，MPR为0.91，并且没有与O-SGA的MPR显着差异（0.90；测试统计量？=？0.29，p？=？0.590）。当将标记的给药时间表应用于计算天数时，LA-SGA MPR上升到0.97，并且与O-SGA的MPR（测试统计量？=？9.60，p？=？0.002）有很大差异。另外，控制过多的药物积累，LA-SGA的MPR降至0.86，这与O-SGA的MPR有很大差异（测试统计量？=？4.01，p？=？0.045）。PDCvaried from 0.55 to 0.61 for LA-SGA but was consistently significantly different from the 0.37PDCvalue of O-SGA (P? less than ?0.05 for each comparison). Standard medication adherence/persistence measures yielded different conclusions when comparing a LA-SGA and an O-SGA, depending on the measure and underlying assumption for days supply. Adherence/persistence measures that address pharmacological differences in terms of formulation and duration of therapeutic drug levels between medications may be necessary and are particularly important as more injectable antipsychotic medications are approved in the United States. Therefore, payers and investigators should consider sensitivity analysis using different adherence/persistence definitions when making product comparisons to ensure confidence in conclusions. |
| SCZ Keywords | schizophrenia, schizophrenic |
| 11 | Curr Med Res Opin 2015 -1 31: 1437-48 |
| PMID | 25978698 |
| Title | 评估针对长效注射抗精神病药治疗的精神分裂症患者的全面信息和援助计划。 |
| Abstract | While atypical long-acting injectable antipsychotics (LAIs) offer the potential for increased adherence, access to medication poses challenges that may hinder their use. Janssen Connect * *Janssen Connect is a registered trade name of Janssen Scientific Affairs, LLC, Titusville, NJ, USA. (JC), a comprehensive information and assistance program, was designed to help patients who received a Janssen LAI initiate and maintain treatment after their health care professional (HCP) determined that the medication was the most clinically appropriate option. We conducted a formative and impact evaluation on early medication adherence of patients enrolled in JC and prescribed paliperidone palmitate. 使用计划管理文件（2010年12月至2014年4月），包括9354例HCP下令帕利替酮棕榈酸酯的患者。总体报道了患者人口统计，临床特征和JC计划的要求，并比较了要求注射中心与没有注射中心的患者之间的比较。根据该计划中的前6个月的治疗，药物依从性并定义为实现？80％的覆盖比例（PDC) was measured for patients receiving ?2 paliperidone palmitate injections (n = 2659). Logistic models evaluated the association between requests for injection centers on medication adherence. Mean age of program enrollees was 40.6 (standard deviation = 13.9 years), 59.3% were men, and 42.5% were Medicare covered. While in the program, 79.9% did not experience a medication gap of ?7 weeks and 87.0% achieved adherence. Injection center request was associated with medication adherence (adjusted odds ratio (aOR) ?5 months: 0.03; 95% confidence interval (CI): 0.02-0.05; ?6 months: aOR: 4.16; 95% CI: 2.72-6.36). The data sources used were designed for program implementation and not for research purposes. The high percentage of patients requesting injection center support and medication shipment in addition to other insurance-related program offerings signals the need for and value of a comprehensive support program for patients seeking LAI therapy. Providing patients with the option of alternative and more conveniently located injection centers may help them start and maintain their treatment. |
| SCZ Keywords | schizophrenia, schizophrenic |