Objective: Examine impact of clinical syndrome, type of medication and adherence on outpatient utilization. Methods: Baseline data predicted 6-month utilization (n=985). Psychotherapy, clinic (specimen collection), and total number outpatient visits examined. Presence of medication (15 first-generation; 5 novel; both) coded. Adherence reflected 4-weeks prior to assessment. Clinical syndromes: deficit, hallucinations/ delusions, disorganization. Negative binomial regression (adjusted standard errors). Results: Psychotherapy Visits: Positive effect for higher hallucinations/delusions and use of both first- and second-generations. Clinic Visits: Probability of visit positively impacted by higher disorganization, adherence. Negative effect for use of novel agents. Number of visits higher for those with higher disorganization. Total Outpatient Visits: Positive effect observed for adherence at both periods and treatment with novel agents alone or in combination with first-generation agents. The clinical syndrome variables did not achieve significance. Conclusions: Medication adherence is an important driver in outpatient services utilization. Type of medication positively impacts the number of visits, however, a negative association was observed between type of medication and the probability of a clinic visit. It is possible that some persons using novel agents achieve improvement through outpatient medication management (psychotherapy visits) and may require less frequent clinic visits (for specimen collection), suggesting that the favorable adverse event profile of second-generation agents may promote community functioning. Positive symptoms and disorganization drive the occurrence and number of visits while deficit syndrome did not achieve significance. These findings suggest that as treatment costs vary by method, payers could benefit by assessing clinical syndrome in order to estimate disease-related payments accurately.
Learning Objectives: Attendees will be able to identify key determinants of outpatient utilization in a schizophrenia population
Keywords: Mental Health, Adherence
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.