Increasing medication adherence and income assistance access for first-episode psychosis patients

PLoS One. 2017 Jun 7;12(6):e0179089. doi: 10.1371/journal.pone.0179089. eCollection 2017.

Abstract

Background: Assertive community treatment for first-episode psychosis programs have been shown to improve symptoms and reduce service use. There is little or no evidence on whether these programs can increase access to income assistance and improve medication adherence in first episode psychosis patients. This research examines the impact of the Early Psychosis Prevention and Intervention Service (EPPIS) on these outcomes.

Methods: We extracted data on EPPIS patients held in the Data Repository at the Manitoba Centre for Health Policy. The Repository is a comprehensive collection of person-level de-identified administrative records, including data from Manitoba's health services. We compared income assistance use and antipsychotic medication adherence in EPPIS patients to a historical cohort matched on pattern of diagnosis. Confounders were adjusted through propensity-score weighting with asymmetrical trimming. Odds ratios (OR), hazard ratios (HR) and 95% confidence intervals were calculated.

Results: We identified a matched sample of 244 patients and 449 controls. EPPIS patients had a higher rate of income assistance use during the program (67·4% vs. 38·7%; p< 0·0001). EPPIS patients were more likely to have been prescribed at least one antipsychotic medication than the control cohort, both during the program (OR = 15·05; 95%CI 10·81 to 20·94) and after the program ended (OR = 5·20; 95%CI: 4·50 to 6·02). Patients in EPPIS were also more likely to adhere to their medication during the program (OR = 4·71; 95%CI 3·75 to 5·92), and after the program (OR = 2·54; 95%CI 2·04 to 3·16).

Conclusion: Enrolment in the EPPIS program was associated with increased adherence to antipsychotic medication treatment and improved uptake of income assistance.

MeSH terms

  • Adult
  • Antipsychotic Agents / therapeutic use*
  • Female
  • Health Services
  • Humans
  • Income
  • Male
  • Manitoba
  • Medication Adherence*
  • Propensity Score
  • Psychotic Disorders / drug therapy*
  • Psychotic Disorders / epidemiology
  • Psychotic Disorders / physiopathology
  • Psychotic Disorders / prevention & control
  • Schizophrenia / drug therapy*
  • Schizophrenia / epidemiology
  • Schizophrenia / physiopathology
  • Schizophrenia / prevention & control
  • Young Adult

Substances

  • Antipsychotic Agents

Grants and funding

This work was supported by the Canadian Institutes of Health Research (CIHR; grant FRN 115206) and the Heart & Stroke Foundation of Canada (grant PG-12-0534), under the program of research entitled “PATHS Equity for Children: A program of research into what works to reduce the gap for Manitoba’s children.” Jason R Randall acknowledges funding from the University of Manitoba’s Graduate Enhancement of Tri-Council Stipends program. Dr Brownell acknowledges the financial support of the Government of Manitoba through the Manitoba Centre for Health Policy Population-Based Child Health Research Award. Dr Bolton is supported by a Canadian Institutes of Health Research New Investigator Award (113589) and a Brain & Behavior Research Foundation NARSAD Young Investigator Grant. None of the funders were involved in the conduct of this study. The corresponding author had full access to the data and responsibility for the decision to submit for publication. The funders of this study did not have any involvement in the design, analysis or interpretation of this study.