A patient perspective of the impact of medication side effects on adherence: results of a cross-sectional nationwide survey of patients with schizophrenia

<p>Abstract</p> <p>Background</p> <p>Antipsychotic medications often have a variety of side effects, however, it is not well understood how the presence of specific side effects correlate with adherence in a real-world setting. The aim of the current study was to examine the relationship between these variables among community-dwelling patients with schizophrenia.</p> <p>Methods</p> <p>Data were analyzed from a 2007-2008 nationwide survey of adults who self-reported a diagnosis of schizophrenia and were currently using an antipsychotic medication (N = 876). The presence of side effects was defined as those in which the patient reported they were at least "somewhat bothered". Adherence was defined as a score of zero on the Morisky Medication Adherence Scale. To assess the relationship between side effects and adherence, individual logistic regression models were fitted for each side effect controlling for patient characteristics. A single logistic regression model assessed the relationship between side effect clusters and adherence. The relationships between adherence and health resource use were also examined.</p> <p>Results</p> <p>A majority of patients reported experiencing at least one side effect due to their medication (86.19%). Only 42.5% reported complete adherence. Most side effects were associated with a significantly reduced likelihood of adherence. When grouped as side effect clusters in a single model, extra pyramidal symptoms (EPS)/agitation (odds ratio (OR) = 0.57, p = 0.0007), sedation/cognition (OR = 0.70, p = 0.033), prolactin/endocrine (OR = 0.69, p = 0.0342), and metabolic side effects (OR = 0.64, p = 0.0079) were all significantly related with lower rates of adherence. Those who reported complete adherence to their medication were significantly less likely to report a hospitalization for a mental health reason (OR = 0.51, p = 0.0006), a hospitalization for a non-mental health reason (OR = 0.43, p = 0.0002), and an emergency room (ER) visit for a mental health reason (OR = 0.60, p = 0.008).</p> <p>Conclusions</p> <p>Among patients with schizophrenia, medication side effects are highly prevalent and significantly associated with medication nonadherence. Nonadherence is significantly associated with increased healthcare resource use. Prevention, identification, and effective management of medication-induced side effects are important to maximize adherence and reduce health resource use in schizophrenia.</p

An evaluation of the relationships between health-related quality of life, disease severity, healthcare utilization, and willingness to give time to an asthma self -management program

The objectives of this study were to: (1) quantify the amount of time patients are willing to devote to an asthma self-management program aimed at improving patient outcomes; (2) to evaluate the relationship between asthma patients\u27 perceived health-related quality of life (HRQL), disease severity, healthcare utilization, and their willingness-to-give-time (WTGT) to an asthma self-management program; and (3) to obtain a better understanding of the Health Belief Model as it relates to preventative health-seeking behavior. The sample for the study consisted of adult asthma patients enrolled in a managed care organization located in central Indiana. To measure HRQL, disease severity, and WTGT, eligible patients were mailed a questionnaire comprised of a generic HRQL scale (the Duke Health Profile), an asthma-specific HRQL scale (the Asthma Quality of Life Questionnaire - Marks), questions regarding the frequency of asthma symptoms, and a contingent valuation scenario measuring WTGT. Healthcare utilization data were obtained from a computerized medical record system. Data were collected during the months of February–April of 2000. The survey data were matched with the utilization data for all respondents. On average, patients were willing to spend 1.5 and 2.5 hours per week for four weeks in an asthma self-management program to experience up to a 45 percent (WTGT45) and 95 percent (WTGT95) improvement in their condition. There was a statistically significant relationship between overall asthma HRQL and WTGT (P \u3c 0.0001) while controlling for age. Symptom-based asthma severity also had a statistically significant relationship with WTGT, P = 0.0006 and P = 0.0092 for WTGT45 and WTGT95 respectively. The healthcare utilization measures did not have a statistically significant relationship with WTGT. HRQL explained more of the variance in WTGT the than symptom-based severity and healthcare utilization. The results suggest that one way to enhance participation in an asthma self-management program is to tell the potential participants an estimation of the magnitude of the program\u27s benefits. The findings also suggest that HRQL may be a good predictor of patients\u27 WTGT to an asthma self-management program thereby affording administrators the opportunity to create self-management programs tailored to the patients\u27 wants or needs