The Medication Adherence in Schizophrenia Management by Using Second Generation Antipsychotics in Taiwan: A Population Study Based on Nhrid


      Schizophrenia is a severe, chronic mental illness and often associated with repeated hospitalizations. Since nonadherence to medication is a recognized problem and may be the most challenging aspect of treatment, the objective in this study was to evaluate the medication adherence in schizophrenia management by using second generation antipsychotics (SGA). The relapse rate, frequencies and duration of hospitalizations, and medication costs of treatment among these adherent and nonadherent patients with schizophrenia were also studied.


      Using the National Health Research Institutes original claim data (NHRID), we selected the schizophrenic patients in the ambulatory care and inpatient care data during year 2010 to 2013 by ICD-9 code 295 and receive SGA medication for more than 12 month. The discontinuation was identified by without any SGA prescription more than 6 month. Medication compliance was identified as total SGA prescription day/treatment period from first SGA prescription to the last SGA prescription.


      2,729 schizophrenic patients receive SGA medication for more than 12 month were enrolled in this study. 524 schizophrenic patients were identified as discontinuation from SGA treatment. Compared with the discontinuation from SGA treatment group, the regular SGA treatment group had a significant higher proportions of high adherent patients (Medication compliance≧0.8) (73.3% v.s. 58.4%, odds ratio (95%CI) =2.11 (1.7-2.7), p<0.001), significant lower proportions of low adherent patients (Medication compliance<0.5) (9.7% v.s. 20.0%, odds ratio (95%CI) =0.43 (0.3-0.5), p<0.001) and also associated with lower relapse hospitalization cost.


      It is important to choose an optimal antipsychotic agent for schizophrenic patients since the patient’s initial experience of treatment has a significant impact on treatment adherence, long-term outcome and relapse prevention. Improving adherence in schizophrenia may have a considerable positive impact on patients and society.