Adherence and outcomes associated with copayment burden in schizophrenia: a cross-sectional survey

Figures & data

Figure 1. Patient flow. *Total sample included in the current study (including analyses of adherence, ER use, hospitalization, attempted suicide, and severe distress). ^†Subsample included for analyses of missed work (since the 241 patients who were not employed had missing data for employment metrics).

Table 1.  The effect of demographics and patient characteristics on the perception of a copayment burden among patients with schizophrenia.

Demographics and characteristics	Total (n = 351)	With copayment burden	Without copayment burden	p-value
		(n = 137)	(n = 214)
Female, %	55.6%	56.2%	55.1%	0.845
Age, mean (SD)	43.4 (11.7)	44.3 (11.6)	42.8 (11.8)	0.235
White, %	63.5%	67.2%	61.2%	0.260
Single, never married, %	46.3%	40.4%	50.0%	0.080
Some college or higher, %	55.3%	62.8%	50.5%	0.024
Employed, %	34.3%	34.6%	34.1%	0.932
Poverty (income < $20,000), %	56.1%	52.6%	58.4%	0.281
Used tobacco, %	70.0%	73.7%	67.6%	0.223
Used alcohol or substance, %	84.6%	85.4%	84.1%	0.744
Number of comorbid conditions, mean (SD)	1.3 (1.3)	1.6 (1.4)	1.2 (1.2)	0.004
Number of psychotropic medications, mean (SD)	3.3 (1.5)	3.5 (1.7)	3.2 (1.3)	0.054
Health insurance, %
Veterans Administration (VA)	5.4%	4.4%	6.1%	0.494
Managed care (no VA, Medicare, Medicaid)	23.9%	27.0%	22.0%	0.280
Medicare/Medicaid (no managed-care)	59.3%	52.6%	63.6%	0.041
Managed care & Medicare/Medicaid	4.3%	6.6%	2.8%	0.089
Online sample, %	16.8%	18.3%	15.9%	0.564

Method: Chi-square for comparisons of percentages and t-tests for comparisons of means.

Table 2.  Unadjusted association of copayment burden with medication adherence and patient outcomes.

Association	Total (n = 351)	With copayment burden	Without copayment burden	p-value
		(n = 137)	(n = 214)
Adherence
Adherence (Morisky Medication Adherence Scale < 2)	64.7%	58.4%	68.7%	0.049
Complete adherence (Morisky Medication Adherence Scale = 0)	39.6%	28.5%	46.7%	0.001
Careless about taking medication	31.1%	35.8%	28.0%	0.127
Forget to take medication	50.4%	61.3%	43.5%	0.001
Stop medication when feel better	25.1%	29.9%	22.0%	0.093
Stop medication when feel worse	23.4%	30.7%	18.7%	0.001
Outcomes
Visited emergency room (ER) in past 6 months	40.7%	52.6%	33.2%	<0.001
Hospitalized in past 6 months	30.8%	40.9%	24.3%	0.001
Suicide attempt in past 6 months	12.5%	17.5%	9.4%	0.024
Severe distress (≤60 on the Psychological General Well Being Scale)	65.7%	74.4%	60.1%	0.006
Of employed …	(n = 110)	(n = 44)	(n = 66)
Missed work in past 6 months due to health	34.6%	56.8%	19.7%	<0.001

Method: Chi-square for comparisons of percentages.

Table 3.  Adjusted association of copayment burden with medication adherence and patient outcomes.

Association	Odds ratio	95% confidence interval		p-value
		Low	High
Adherence
Adherence (Morisky Medication Adherence Scale <2)	0.627	0.386	1.021	0.060
Complete adherence (Morisky Medication Adherence Scale = 0)	0.427	0.257	0.711	0.001
Careless about taking medication	1.450	0.880	2.390	0.145
Forget to take medication	2.058	1.270	3.335	0.003
Stop medication when feel better	1.592	0.930	2.725	0.090
Stop medication when feel worse	2.000	1.140	3.507	0.016
Outcomes
Visited emergency room (ER) in past 6 months	2.157	1.322	3.520	0.002
Hospitalized in past 6 months	2.512	1.475	4.277	<0.001
Suicide attempt in past 6 months	2.385	1.156	4.920	0.019
Severe distress (≤60 on the Psychological General Well Being Scale)	1.833	1.092	3.075	0.022
Missed work in past 6 months due to health*	7.193	2.554	20.256	<0.001

Method: Logistic regression adjusting for gender, age, race, marital status, education, employment, poverty, tobacco use, alcohol/substance use, comorbid conditions, count of psychotropic medications, insurance status, and interview site.

*Analysis limited to eligible subjects who were employed full-time or part-time (n = 110).