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Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 24, Issue 2, 2021. Pages: 47-59
Published Online: 1 June 2021

Copyright © 2021 ICMPE.


 

Characteristics and Healthcare Burden of Patients with Schizophrenia Treated in a US Integrated Healthcare System

Rohan Mahabaleshwarkar,1* Dee Lin,2 Kruti Joshi,3 Jesse Fishman,4 Todd Blair,5 Timothy Hetherington,5 Pooja Palmer,5 Charmi Patel,6 Constance Krull,7 Oleg V. Tcheremissine8

1Ph.D., Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC, USA
2PharmD, M.S., Janssen Scientific Affairs, LLC, Titusville, NJ, USA
3MPH, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
4PharmD, MSc, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
5MS, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC, USA
6MPH, RN, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
7MSPH, Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC, USA
8MD, Behavioral Health Charlotte, Atrium Health, Charlotte, NC, USA

* Correspondence to: Rohan Mahabaleshwarkar, 1540 Garden Terrace Suite 410, Charlotte NC, 28203, USA.
Tel.: +1-704-355 9958
Fax: +1-704-355 6077
E-mail: Rohan.Mahabaleshwarkar@atriumhealth.org 

Source of Funding: This research was funded by Janssen Scientific Affairs, LLC.

Disclosures: DL, JF, KJ, and CP are employees of Janssen Scientific Affairs, LLC and stockholders of Johnson & Johnson, Inc. OVT reports direct research support from Roche, Eli Lilly, and Janssen. RM, TB, TH, PP, and CK have no conflicts of interest to report.

Abstract
This retrospective electronic medical record-based study examined healthcare utilization in adults with schizophrenia in a US integrated healthcare system. Patients with 2 diagnostic codes for schizophrenia within 12 months during January 2009 to June 2018 were included. Patients were followed until no longer receiving active care (two annual visits) or study ended. Among 2,941 patients (mean age, 48.3 years, 54.5% male, 51.8% black), during follow-up, 48.7% had an inpatient visit and 68.4% had an emergency room (ER) visit, while 53.3% with a schizophrenia-related inpatient visit did not have a 30-day outpatient follow-up visit. Findings differed by race/ethnicity, age, and sex with non-Hispanic black patients and patients aged 18-35 years (vs. 36-64 years) more likely to have an inpatient and ER visit and women less likely to receive antipsychotics. The findings indicate a need for strategies for improving efficiency and quality of care, and for optimizing healthcare across demographic subgroups.

 

Background: Schizophrenia is one of 15 major causes of disability worldwide and is responsible for more than $150 billion in annual healthcare costs in the United States. Although the burden of schizophrenia as measured by healthcare resource utilization (HRU) is known to be considerable, data generally come from claims databases or healthcare systems/payors representing only a subset of patients, such as Medicare/Medicaid recipients. A broader understanding of HRU across the schizophrenia patient population would help identify underserved groups and inform strategies for improving healthcare delivery.

Aims of the Study: This observational study examined overall HRU and the influence of sociodemographic factors in adult patients with schizophrenia receiving care in a US integrated healthcare system.

Methods: A retrospective cohort study was conducted using data from electronic medical records (EMRs). Patients were required to have at least two diagnostic codes for schizophrenia recorded in the EMR within a 12-month period from January 2009 to June 2018, and to have received active care (> 1 in-system healthcare visit every six months) for at least 12 months before and after the index date (the earlier of the schizophrenia diagnosis dates). Patients were followed until no longer receiving active care or the end of the study. Patient characteristics were assessed during the 12-month pre-index period, and inpatient, readmission, emergency room (ER), and outpatient visits and antipsychotic prescriptions were described during follow-up. Findings were reported overall and in subgroups by race/ethnicity, age, and sex.

Results: The study cohort included 2,941 patients (mean age, 48.3 years; 54.5% male, 51.8% black, 45.8% with Medicare). During the follow-up period (mean, 4.6 years), inpatient hospital stays were common, with at least one all-cause, mental health-related, or schizophrenia-related inpatient visit occurring for 48.7%, 47.3%, and 38.8% of patients, respectively. Hospital readmissions within 30 days of an all-cause inpatient visit occurred in 20.4% of patients, with 14.5% of patients readmitted within 30 days of a schizophrenia-related inpatient visit. More than two-thirds of patients had ER visits, and 40.7% had schizophrenia-related ER visits. Only 46.7% of patients with a schizophrenia-related inpatient visit and 58.5% of patients with a mental health-related inpatient visit had a 30-day outpatient follow-up visit. Subgroup analyses revealed that a larger proportion of non-Hispanic black vs non-Hispanic white patients had 30-day outpatient follow-up visits, ER visits, mental health specialist visits, and antipsychotic prescriptions. Moreover, older age was associated with fewer ER and mental health specialist visits and less use of injectable and second-generation antipsychotics, and women were less likely than men to receive antipsychotic therapy, particularly injectable medications.

Discussion: Patients with schizophrenia receiving care in a US integrated healthcare system had considerable acute HRU and suboptimal rates of routine and follow-up care. Inequities in schizophrenia burden and care were observed in demographic subgroups.

Implications for Health Policies: Population health management strategies focusing on efficient resource allocation and improving healthcare quality are needed to reduce the burden of schizophrenia. Differential findings by race/ethnicity, age, and sex indicate the need for optimizing approaches to care in these subgroups.

Received 21 November 2020; accepted 4 May 2021

Copyright 2021 ICMPE