ORIGINAL CONTRIBUTION
Long-Acting Injectables and Risk for Rehospitalization Among Patients With Schizophrenia in the Home Care Program in Taiwan Po-Chung Ju, MD,*Þ Frank Huang-Chih Chou, MD, MS, PhD,þ§ Te-Jen Lai, MD, PhD,*Þ Po-Ya Chuang, MHA,|| Yung-Jung Lin, MS,¶ Ching-Wen Wendy Yang, BS,# and Chao-Hsiun Tang, PhD||
Abstract: We aimed at evaluating the relationship between medication and treatment effectiveness in a home care setting among patients with schizophrenia. Patients with schizophrenia hospitalized between 2004 and 2009 with a primary International Classification of Diseases, Ninth Revision, Clinical Modification code of 295 were identified from Psychiatric Inpatient Medical Claims Data released by the National Health Research Institute in Taiwan. Patients who joined the home care program after discharge and were prescribed long-acting injection (LAI) (the LAI group) or oral antipsychotic medications (the oral group) were included as study subjects. The final sample for the study included 810 participants in the LAI group and 945 in the oral group. Logistic regression was performed to examine the independent effect of LAI medication on the risk for rehospitalization within the 12-month observation window after controlling for patient and hospital characteristics and propensity score quintile adjustment. The unadjusted odds ratio for rehospitalization risk was 0.80 (confidence interval, 0.65Y0.98) for the LAI group compared to the oral group. The adjusted odds ratio was further reduced to 0.78 (confidence interval, 0.63Y0.97). Results remained unchanged when the propensity score quintiles were entered into the regression for further adjustment. In a home care setting, patients treated with long-acting antipsychotic agents are at a significantly lower risk for psychiatric rehospitalization than those treated with oral medication. Consequently, LAI home-based treatment for the prevention of schizophrenia relapse may lead to substantial clinical and economic benefits. Key Words: home care, logistic regression, long-acting injection, risperidone, schizophrenia (J Clin Psychopharmacol 2014;34: 23Y29)
S
chizophrenia is a chronic and burdensome mental illness that can have a major impact on an affected person’s capacity for social adaptation and occupational function.1Y6
From the *Department of Psychiatry, Chung Shan Medical University Hospital; †Institute of Medicine, Chung Shan Medical University, Taichung; ‡Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City; §Graduate Institute of Health Care, Meiho University, Ping-Tong County; ||School of Health Care Administration, Taipei Medical University, Taipei; ¶Division of Corporate Communications and Government Affairs, Janssen Taiwan, Taipei, Taiwan; and #School of Health Sciences, University of CaliforniaYIrvine, Irvine, CA. Received November 1, 2011; accepted after revision April 23, 2013. Reprints: Chao-Hsiun Tang, PhD, School of Health Care Administration, Taipei Medical University, 250 Wu-Xin St, Taipei, Taiwan 110 (e
Long-Acting Injectables and Risk for Rehospitalization Among Patients With Schizophrenia in the Home Care Program in Taiwan Po-Chung Ju, MD,*Þ Frank Huang-Chih Chou, MD, MS, PhD,þ§ Te-Jen Lai, MD, PhD,*Þ Po-Ya Chuang, MHA,|| Yung-Jung Lin, MS,¶ Ching-Wen Wendy Yang, BS,# and Chao-Hsiun Tang, PhD||
Abstract: We aimed at evaluating the relationship between medication and treatment effectiveness in a home care setting among patients with schizophrenia. Patients with schizophrenia hospitalized between 2004 and 2009 with a primary International Classification of Diseases, Ninth Revision, Clinical Modification code of 295 were identified from Psychiatric Inpatient Medical Claims Data released by the National Health Research Institute in Taiwan. Patients who joined the home care program after discharge and were prescribed long-acting injection (LAI) (the LAI group) or oral antipsychotic medications (the oral group) were included as study subjects. The final sample for the study included 810 participants in the LAI group and 945 in the oral group. Logistic regression was performed to examine the independent effect of LAI medication on the risk for rehospitalization within the 12-month observation window after controlling for patient and hospital characteristics and propensity score quintile adjustment. The unadjusted odds ratio for rehospitalization risk was 0.80 (confidence interval, 0.65Y0.98) for the LAI group compared to the oral group. The adjusted odds ratio was further reduced to 0.78 (confidence interval, 0.63Y0.97). Results remained unchanged when the propensity score quintiles were entered into the regression for further adjustment. In a home care setting, patients treated with long-acting antipsychotic agents are at a significantly lower risk for psychiatric rehospitalization than those treated with oral medication. Consequently, LAI home-based treatment for the prevention of schizophrenia relapse may lead to substantial clinical and economic benefits. Key Words: home care, logistic regression, long-acting injection, risperidone, schizophrenia (J Clin Psychopharmacol 2014;34: 23Y29)
S
chizophrenia is a chronic and burdensome mental illness that can have a major impact on an affected person’s capacity for social adaptation and occupational function.1Y6
From the *Department of Psychiatry, Chung Shan Medical University Hospital; †Institute of Medicine, Chung Shan Medical University, Taichung; ‡Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City; §Graduate Institute of Health Care, Meiho University, Ping-Tong County; ||School of Health Care Administration, Taipei Medical University, Taipei; ¶Division of Corporate Communications and Government Affairs, Janssen Taiwan, Taipei, Taiwan; and #School of Health Sciences, University of CaliforniaYIrvine, Irvine, CA. Received November 1, 2011; accepted after revision April 23, 2013. Reprints: Chao-Hsiun Tang, PhD, School of Health Care Administration, Taipei Medical University, 250 Wu-Xin St, Taipei, Taiwan 110 (e
