Identifying Predictors of Primary Adherence to Second Generation Long-Acting Injectable Antipsychotics Following Discharge from an Acute Inpatient Psychiatry Unit

Objectives

Describe primary adherence and medication persistence to second generation long-acting injectable (LAI) antipsychotics following an inpatient psychiatry hospitalization, compare rates of psychiatric-related hospital readmissions and emergency visits within 6 months of discharge between patients who were adherent versus nonadherent, and explore predictors of primary adherence to second generation LAI antipsychotics following hospitalization.

Experimental Design

This retrospective chart review included patients who received at least 1 dose of a second-generation LAI antipsychotic while hospitalized in an acute care psychiatry unit between April 1, 2016 and July 31, 2017, had active Missouri Medicaid, and continued on the second-generation LAI antipsychotic upon discharge. Patients were excluded if they were discharged to a care setting where medication was administered.

Principal Observations

Seventy-five charts were included. Primary adherence rate was 37% and only 46% of those persisted with LAI antipsychotic treatment over a 6-month time period following discharge. Rates of psychiatric-related readmission or emergency visit within 6 months post-discharge did not differ between groups. No statistically significant correlations between primary adherence and demographic or socioeconomic variables were found.

Conclusions

Primary adherence and medication persistence to second generation LAI antipsychotics following hospital discharge is low with approximately 60% of patients not receiving another injection. Clinicians should consider outpatient medication adherence before initiating a second-generation LAI antipsychotic during hospitalization. Efforts should be made to facilitate adherence to LAI antipsychotics during transition of care from inpatient to outpatient settings.