Most People With Schizophrenia Don't Take Meds as Directed: Study

Non-compliance causes higher medical costs and more hospitalizations

THURSDAY, April 1, 2004 (HealthDayNews) -- Although anti-psychotic medications can help people with schizophrenia live more normal lives, almost 60 percent don't take these medications as prescribed by their doctors.

And that non-compliance leads to higher medical costs, according to a new study in the April issue of the American Journal of Psychiatry.

"We looked at adherence to anti-psychotic medications because they form the backbone of treatment for schizophrenics," said study co-author Dr. Dilip Jeste, a professor of psychiatry and neurosciences at the University of California, San Diego. "These medications are good, but they only work when taken properly."

Schizophrenia, a chronic disease of the brain, affects about 1 percent of the U.S. population, according to the National Institute of Mental Health. Symptoms can include hallucinations, delusions, paranoia, disordered thinking and difficulty expressing emotions.

For this study, Jeste and his colleagues reviewed claims and eligibility data for 1,619 people with schizophrenia who were receiving treatment between 1998 and 2000. The data were provided by the San Diego County Adult Mental Health Services and Medi-Cal, California's Medicaid program.

Most of the study subjects were between 30 and 59 -- the average age was 42. Fifty-six percent were men. Twenty-five percent of the group also had a known substance-abuse problem. Half lived on their own, while 19 percent lived with family. Another 25 percent lived in assisted-living facilities and 5 percent were homeless.

Only 41 percent of the people studied took their medication as prescribed. Twenty-four percent were non-adherent, which meant they filled less than 50 percent of their anti-psychotic medication prescriptions, Jeste said. Seventeen percent were partially adherent, which meant they filled between 50 percent and 80 percent of their prescriptions.

What surprised the researchers was the number of "excess fillers" they discovered. Nearly 20 percent of the people studied filled prescriptions for more medication than they needed.

Not surprisingly, psychiatric hospitalizations were much higher for those who didn't take their medications as prescribed. People who were non-adherent were two and half times as likely to be hospitalized for psychiatric reasons. Those who were partially adherent or "excess fillers" were 80 percent more likely to be hospitalized.

Even hospitalizations for non-psychiatric reasons were higher for those who didn't follow their drug regimen. Those who were non-compliant or excess fillers were 70 percent more likely to be hospitalized for medical reasons than people who adhered to their drug schedule. Those who were partially compliant were 30 percent more likely to have a medical hospitalization.

Hospital costs were three times as high for people who didn't take their medication properly compared to those who did. Costs for people who were partially adherent or excess fillers were about two and half times higher.

Dr. Hiten Patel, a psychiatrist at William Beaumont Hospital in Royal Oak, Mich., said the study's findings aren't surprising. "We know that there is a very high degree of non-compliance in people with schizophrenia," he said.

Jeste said the researchers weren't able to discern the reasons for non-compliance from the available data. They did find that younger patients and substance abusers were less likely to take their medication as directed. People living with family or in assisted-living settings were more likely to follow prescriptions.

Both Jeste and Patel recommended bolstering community mental health systems, so support is available for people with schizophrenia.

"We expect these people who are seriously mentally ill to take their medication, sometimes several times a day or multiple medications, and it's really hard," Jeste said. "Instead of blaming patients, we need to provide education to help them understand why they need the medication, and case management helps. If there is someone else who is interested and helping them, medication adherence will likely improve significantly."

Patel said if you have a family member or friend who has schizophrenia, you can help them adhere to their prescriptions. He said be supportive, but also be vigilant that they're taking their medications, adding that it's a good idea to actually check the prescription bottles to make sure the right amount of pills have been taken.

More information

To learn more about schizophrenia, visit the National Institute of Mental Health or the American Psychiatric Association.

Read this Next
About UsOur ProductsCustom SolutionsHow it’s SoldOur ResultsDeliveryContact UsBlogPrivacy PolicyFAQ