Treatment adherence of a case managed program for patients with severe schizophrenia compared to standard care in mental health units.

Abstract

Introduction

Although some studies have reported that case management (CM), when is compared with standard care, reduces the loss of contact with health services, the debate continues about its superiority over other treatment models.

Objectives

To assess treatment adherence and reasons for treatment discontinuation, and the impact of the type of APs administration on it, for a group of patients with schizophrenia treated in a CMP or receiving standard treatment in mental health units (MHUs).

Methods

An observational, longitudinal study (ten-year follow-up) was conducted on 688 patients with severe schizophrenia (CGI-S ≥ 5). All the causes of the end of treatment were recorded, together with the AP medication prescribed and kind of regimes.

Results

43.6% of the patients had discontinued treatment in MHUs and only 12.1% on the CMP (p < 0.0001). 27.6% of patients in MHUs were on long-acting injectables (LAIs), and 57.6 on the CMP (p < 0.001). Treatment discontinuation was closely linked to be on OAPs medication in both cases (p < 0.001).Table 1.Treatment discontinuation, hospital admissions and suicide attempts [N(%)]

N= 688	MHU (N=344)	CMP (N= 344)	P value
Treatment discontinuation	290 (84.3)	42 (12.2)	<0.00001
	OAP	LAI	OAP	LAI
Treatment discontinuation	180(52.3)	90(26.2)a	34(9.9)	8(2.3)b
Hospital admissions	260 (75.6)	80 (23.5)	<0.001
	OAP	LAI	OAP	LAI
Hospital admissions	180 (52.3)	80 (23.5)a	65 (18.9)	15 (4.4)b
Suicide attempts	134 (38.9)	26 (7.7)	<0.0001
	OAP	LAI	OAP	LAI
Suicide attempts	160(46.5)	74(21.5)a	18(5.2)	8(2.3)b

^a: p<0.01 ^b: p<0.001 N: number of patients %: percentage of patients

MHU: mental health unit CMP: case managed programme

AP: antipsychotic FGA, SGA: first, second generation antipsychotic

OAP: oral antipsychotic LAI: long-acting injectable antipsychotic

Conclusions

Our findings show how specific strategies as programs with an integrated treatment and case-managed approach, increase adherence. Moreover, treating with LAI APs clearly contributes to the achievement of these results. The widespread implementation of comprehensive community programs with case management, and the use of LAI-APs, should be an effective choice for people with schizophrenia and clinical severity and impairment, and at high risk of treatment discontinuation.

Disclosure of Interest

None Declared