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Adherence to antipsychotic medication among homeless adults in Vancouver, Canada: a 15-year retrospective cohort study

Social Psychiatry and Psychiatric Epidemiology volume 51, pages 1623–1632 (2016)Cite this article

Abstract

Purpose

The purpose of this study was to investigate the level of adherence to antipsychotic prescription medication in a well-defined homeless cohort over a 15-year period. We hypothesized that adherence would be well below the recommended threshold for clinical effectiveness (80 %), and that it would be strongly associated with modifiable risk factors in the social environment in which homeless people live.

Method

Linked baseline data (including comprehensive population-level administrative prescription records) were examined in a subpopulation of participants from two pragmatic-randomized trials that investigated Housing First for homeless and mentally ill adults. Adherence to antipsychotic medication was operationalized using the medication possession ratio. Multivariable logistic regression was used to estimate effect sizes between socio-demographic, homelessness-related and illness factors, and medication possession ratio.

Results

Among the 290 participants who met inclusion criteria for the current analysis, adherence to antipsychotic prescription was significantly associated with: history of psychiatric hospitalization; receipt of primary medical services; long-acting injectable antipsychotic formulations; and duration of homelessness. Mean medication possession ratio in the pre-randomization period was 0.41. Socio-demographic characteristics previously correlated with antipsychotic non-adherence were not significantly related to medication possession ratio.

Conclusions

This is the first study to quantify the very low level of adherence to antipsychotic medication among homeless people over an extended observation period of 15 years. Each of the four factors found to be significantly associated with adherence presents opportunities for intervention. Strategies to end homelessness for this population may represent the greatest opportunity to improve adherence to antipsychotic medication.

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Notes

  1. See: http://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/pharmanet.

  2. PharmaNet introduced a Maximum Days’ Supply policy in 1996.

  3. Beginning January 1, 1996.

  4. Residents of British Columbia who are diagnosed with mental illness who demonstrate clinical and financial need are eligible for the provincial no-charge psychiatric medication plan. Income assistance recipients are also eligible for 100 % coverage of eligible prescription costs.

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Acknowledgments

SNR is a Doctoral Candidate and receives funding for her research from the Imperial Order Daughters of the Empire and the Canadian Institutes of Health Research. SF receives research funding from Wellcome Trust (095806). The authors gratefully acknowledge support of the British Columbia Inter-Ministry Research Initiative (IMRI) and members of the IMRI Steering committee. SNR would also like to acknowledge the support of her Doctoral Committee members: Drs. Julian M Somers, Robert Hogg, Lawrence McCandless and Simon Verdun-Jones.

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Authors and Affiliations

  1. Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada

    Stefanie N. Rezansoff, A. Moniruzzaman & J. M. Somers

  2. Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, 0X3 7JX, UK

    S. Fazel

  3. Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada

    R. Procyshyn

Authors
  1. Stefanie N. Rezansoff
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  2. A. Moniruzzaman
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  3. S. Fazel
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  4. R. Procyshyn
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  5. J. M. Somers
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Correspondence to Stefanie N. Rezansoff.

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Rezansoff, S.N., Moniruzzaman, A., Fazel, S. et al. Adherence to antipsychotic medication among homeless adults in Vancouver, Canada: a 15-year retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 51, 1623–1632 (2016). https://doi.org/10.1007/s00127-016-1259-7

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  • DOI: https://doi.org/10.1007/s00127-016-1259-7

Keywords

  • Antipsychotic
  • Adherence
  • Homelessness
  • Medication possession ratio
  • Serious mental illness