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

• Published in: PloS one 2017-06, Vol.12 (6), p.e0179089-e0179089
• Main Authors: Randall, Jason, Chateau, Dan, Bolton, James M, Smith, Mark, Katz, Laurence, Burland, Elaine, Taylor, Carole, Nickel, Nathan C, Enns, Jennifer, Katz, Alan, Brownell, Marni
• Format: Article
• Language: English
• Subjects: Adhesion; Adult; Analysis; Antipsychotic agents; Antipsychotic Agents - therapeutic use; Antipsychotics; Asymmetry; Chief executive officers; Collection; Communities; Confidence intervals; Diagnosis; Dosage and administration; Drug therapy; Drugs; Economic aspects; Epidemiology; Female; Health; Health aspects; Health care policy; Health policy; Health sciences; Health Services; Humans; Income; Intervention; Male; Manitoba; Mathematical analysis; Medical diagnosis; Medication Adherence; Medicine; Medicine and Health Sciences; Mental disorders; Mental health; Patient compliance; Patients; People and places; Prevention; Propensity Score; Psychiatric patients; Psychiatry; Psychosis; Psychotherapy; Psychotic disorders; Psychotic Disorders - drug therapy; Psychotic Disorders - epidemiology; Psychotic Disorders - physiopathology; Psychotic Disorders - prevention & control; Schizophrenia; Schizophrenia - drug therapy; Schizophrenia - epidemiology; Schizophrenia - physiopathology; Schizophrenia - prevention & control; Socioeconomic factors; Trimming; Weighting; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0179089

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