Abstract
Objective
Overestimating patients’ medication adherence diminishes the ability of psychiatric care providers to prescribe the most effective treatment and to identify the root causes of treatment resistance in schizophrenia. This study was conducted to determine how credible patient drug adherence information (PDAI) might change prescribers’ treatment decisions.
Methods
In an online survey containing 8 clinical case vignettes describing patients with schizophrenia, health care practitioners who prescribe antipsychotics to patients with schizophrenia were instructed to choose a preferred treatment recommendation from a set of predefined pharmacologic and non-pharmacologic options. The prescribers were randomly assigned to an experimental or a control group, with only the experimental group receiving PDAI. The primary outcome was the prescribers’ treatment choice for each case. Between-group differences were analyzed using multinomial logistic regression.
Results
A convenience sample (n=219) of prescribers completed the survey. For 3 nonadherent patient vignettes, respondents in the experimental group were more likely to choose a long-acting injectable antipsychotic compared with those in the control group (77.7% experimental vs 25.8% control; P<0.001). For 2 adherent but poorly controlled patient vignettes, prescribers who received PDAI were more likely to increase the antipsychotic dose compared with the control group (49.1% vs 39.1%; P<0.001). For the adherent and well-controlled patient vignette, respondents in both groups made similar treatment recommendations across all choices (P=0.099), but respondents in the experimental arm were more likely to recommend monitoring clinical stability (87.2% experimental vs 75.5% control, reference group).
Conclusion
The results illustrate how credible PDAI can facilitate more appropriate clinical decisions for patients with schizophrenia.
Video abstract
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Supplementary materials
Table S1 Distribution of key patient characteristics in vignettes
Table S2 Descriptions of clinical vignettes
Acknowledgments
Funding for this study was provided by Otsuka Pharmaceutical Development & Commercialization, Inc. Editorial support for the development of this manuscript was provided by Vandana Sharma, PhD, at C4 MedSolutions, LLC (Yardley, PA), a CHC Group company, and was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. This study was presented at the American Society of Clinical Psychopharmacology Annual Meeting, held on May 30–June 3, 2016, in Scottsdale, AZ, and the 29th Annual U.S. Psychiatric and Mental Health Congress, held on October 21–24, 2016, in San Antonio, TX.
Disclosure
Jason Shafrin, Suepattra G May, Anshu Shrestha, and Darius Lakdawalla are employees of Precision Health Economics, a health care consulting firm that received funding for this study from Otsuka. Charles Ruetsch and Nicole Gerlanc are employees of Health Analytics, LLC, a contract research company compensated by Otsuka to conduct the study. Felicia Forma is an employee of Otsuka Pharmaceutical Development & Commercialization, Inc. Ainslie Hatch is an employee of ODH, Inc and was an employee of Otsuka Pharmaceutical Development and Commercialization during this research project. Jean-Pierre Lindenmayer is a paid consultant for Otsuka and has received research support from Janssen, Alkermes, Forum, Neurocrine, and Avanir. The authors report no other conflicts of interest in this work.