Identifying longitudinal medication adherence patterns of antipsychotic treatments: A real-world cohort study in Catalonia, Spain.
Por:
Fuente M, Cahir C, Passos VL, Bennett K, Walsh C, Hermida-González P, Peláez de Loño J, Abella MER, Baladon L, Rubio-Valera M, Serrano-Blanco A and Aznar I
Publicada:
1 jun 2025
Ahead of Print:
9 feb 2025
Resumen:
AIMS: Suboptimal adherence to antipsychotics leads to poorer outcomes and relapse. Several factors, including the formulation and number of antipsychotics, may influence medication adherence. This study aimed to identify longitudinal adherence patterns to oral and long-acting injectable (LAI) antipsychotics in monotherapy/polypharmacy through group-based trajectory modelling (GBTM). METHODS: This was a retrospective cohort study that linked prescription and dispensing data of adult patients with a new antipsychotic prescribed between 2015 and 2019 in Catalonia (Spain). GBTM was used to classify patients following a similar longitudinal pattern of adherence. The response variable was adherence, estimated through the continuous medication availability measure (CMA), in each 30-day period during 12 months of follow-up. Baseline and treatment characteristics were used to characterize the trajectories identified. RESULTS: Among the 7730 patients included in the study, we identified seven clinically distinct trajectory groups of adherence to antipsychotics: non-initiation (19%), low implementation (9%), immediate discontinuation (6%), mid-discontinuation (5%), late-discontinuation (5%), high implementation (21%), and full implementation (35%). Trajectories with better adherence were more likely to receive the prescription from a psychiatrist, receive LAIs and have previous exposure to other antipsychotics. Intermittent medication use and high levels of polypharmacy were characteristics of the "low" and "high implementation" groups. CONCLUSIONS: Targeting newly prescribed patients by improving the clinician-patient relationship could be particularly valuable, as they seem more likely to not initiate or discontinue treatment immediately compared to patients in other groups. Patients on polypharmacy should have more regular adherence monitoring and LAIs should be considered, as they appear to be associated with better adherence.
Filiaciones:
Fuente M:
Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
Cahir C:
Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
Passos VL:
School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
Bennett K:
Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
Walsh C:
School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
Discipline of Pharmacology & Therapeutics, School of Medicine, Trinity College Dublin, Ireland
Hermida-González P:
Unitat de Farmàcia. Àmbit Metropolità Sud-Regió Sanitària Barcelona. CatSalut, Spain
Peláez de Loño J:
Unitat de Farmàcia. Àmbit Metropolità Sud-Regió Sanitària Barcelona. CatSalut, Spain
Abella MER:
Unitat de Farmàcia. Àmbit Metropolità Sud-Regió Sanitària Barcelona. CatSalut, Spain
Baladon L:
Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
Rubio-Valera M:
Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Serrano-Blanco A:
Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Aznar I:
Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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