Continuity of care among patients newly initiated on second-generation oral or long-acting injectable antipsychotics during a schizophrenia-related inpatient stay

Abstract

Background

Maintaining continuity of care after schizophrenia-related hospitalization is challenging for patients and healthcare providers and systems. Prior evidence suggests that second-generation long-acting injectable antipsychotics (SGLAIs) may reduce the risk of treatment nonadherence and readmission versus oral atypical antipsychotics (OAAs). Therefore, quality measures were compared between patients initiated on SGLAIs and OAAs in the United States.

Methods

Adults newly initiated on an SGLAI or OAA during a schizophrenia-related inpatient stay were identified in HealthVerity databases (01/2015–12/2020); the index date was the hospital discharge date. Patients had continuous health insurance coverage for pharmacy and medical services for 6 months pre-admission and post-discharge from the inpatient stay and ≥1 pharmacy or medical claim (i.e. treatment as indicated by the observed insurance claims) for an antipsychotic other than the index SGLAI or OAA in the 6 months pre-admission. Antipsychotic use and adherence, and schizophrenia-related readmissions and outpatient visits were compared during the 6-month period post-discharge. Characteristics between cohorts were balanced using inverse probability weights.

Results

Post-discharge, only 36.9% and 40.7% of weighted SGLAI (N = 466) and OAA (N = 517) patients had ≥1 pharmacy or medical claim for the antipsychotic initiated during the inpatient stay, among whom SGLAI patients were 4.4 times more likely to be adherent to that antipsychotic compared to OAA patients (p < .001). Additionally, SGLAI patients were 2.3 and 3.0 times more likely to have a pharmacy or medical claim for and be adherent to any antipsychotic relative to OAA patients (including index antipsychotic; all p < .001). Within 7 and 30 days post-discharge, 1.7% and 13.0% of SGLAI patients and 4.1% and 12.6% of OAA patients had a readmission. Further, SGLAI patients were 51% more likely to have an outpatient visit compared to OAA patients (p = .044).

Conclusions

Less than half of patients initiated on antipsychotics during a schizophrenia-related inpatient stay continued the same treatment post-discharge. However, SGLAI patients were more likely to be adherent to the initiated antipsychotic and to have an outpatient visit, which may suggest improved continuity of care post-discharge relative to OAA patients.

Keywords:

• Schizophrenia
• long-acting injectable antipsychotic
• healthcare resource utilization
• hospitalization
• continuity of care

Transparency

Declaration of funding

Financial support for this research was provided by Janssen Scientific Affairs, LLC. The study sponsor was involved in several aspects of the research, including the study design, the interpretation of data, the writing of the manuscript.

Declaration of financial/other relationships

CP and CB are employees of Janssen Scientific Affairs, LLC and stockholders of Johnson & Johnson.

DP, LM, CH, MHL, and PL are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, which funded the development and conduct of this study and manuscript. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors meet the 4 ICMJE criteria for authorship of this manuscript. DP, LM, CH, MHL, and PL contributed to study conception and design, collection and assembly of data, and data analysis and interpretation. CP and CB contributed to study conception and design, data analysis and interpretation. All authors reviewed and approved the final content of this manuscript.

Acknowledgements

Medical writing support was provided by Cody Patton, BSc, an independent consultant, and Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC., which funded the development and conduct of this study and manuscript.

Data availability statement

The authors declare that the data supporting the findings of this study are available within the article and its supplementary information files.

Data that support the findings of this study were used under license from HealthVerity. Restrictions apply to the availability of these data, which are not publicly available and cannot be shared. The data are available through request made directly to the data vendor, subject to the data vendor’s requirements for data access.

Previous presentation

Part of the material in this manuscript was presented at Psych Congress 2022 from September 17-20 in New Orleans, LA.