Adherence assessments and the use of depot antipsychotics in patients withschizophrenia

Background: Antipsychotic medications significantly ameliorate the symptoms of schizophrenia, but patients are often noncompliant with these medicatio ns. Research evidence supports the use of depot antipsychotics in noncompli ant patients. Method: Between January 9, 1991, and December 19, 1995, 1307 veterans with schizophrenia or schizoaffective disorder (ICD-9) were enrolled in a study of enhanced psychosocial programming at 14 Veterans Administration Medical Centers. All had a history of high inpatient use. At enrollment, clinicians listed patient medications, rated patient compliance, and completed a Brie f Psychiatric Rating Scale (BPRS) and Global Assessment of Functioning (GAF ). Patients reported medication side effects. We describe depot antipsychot ic use among these patients and examine the relationship between depot use, assessed compliance, and patient characteristics. Results: At enrollment, 18% of patients in this cohort were receiving depot antipsychotics however, clinicians reported that 49% had been noncompliant with medication in the past year. Depot use varied significantly with trea tment site, African Americans were more likely to receive depot antipsychot ics and less likely to receive atypical antipsychotics than white patients. Patients on depot and oral agents had similar levels of psychiatric sympto ms, but patients on depot antipsychotics were more likely to receive high d oses and complain of side effects. Conclusion: Clinicians prescribed depot antipsychotics relatively infrequen tly, despite high rates of noncompliance and high levels of inpatient use. Variation in use with treatment site and ethnic group suggests barriers to implementing research-based recommendations for depot use in noncompliant p atients. Quality improvement programs should consider facilitating the appr opriate use of depots.