Long-Acting Medications Compared with Hospital Readmission Rates
May 9, 2019
Aurora Charter Oak Hospital congratulates our pharmacist, Dr. Carol Yuan, on the recent publication of her study which examined the use of long-acting injectable antipsychotic medications. Overall, the use of these medications has been demonstrated to help avoid re-hospitalizations within a 30-day period. Dr. Yuan's study indicated a statistical difference between some of the medications and the rate of re-hospitalization. Click here to see the PDF file.
Title: Comparison Of Long-Acting Injectables In The Treatment Of Mental Illness To Prevent Hospital Readmission In Less Than 30 Days After Discharge: A Retrospective Study
Authors & Affiliates: Carol Yuan, Pharm.D, BCPP [1,2], Ji Haeng Heo, PhD , Busuyi Olotu, BPharm, MSPharm, PhD , Annie Hiu, BS , Michael Pondrom, PharmD, BCPP , Maria D. Arredondo .
1. Aurora Charter Oak Hospital, Department of Pharmacy, 2. Cardinal Health, 3. Genesis Research, 4. West Coast University School of Pharmacy.
Purpose: Long-acting injectable antipsychotics (LAIs) have been established since the 1960s. They were developed to improve medication adherence and reduce relapse. However, there is limited information when comparing LAIs in terms of their effectiveness to reduce hospital readmission. This retrospective study compared different LAIs in hospital readmission in <30 days in an acute care psychiatric hospital.
Methods: Retrospective study of 607 patients ≥18 years old with DSM-V criteria for bipolar I (n = 28), bipolar II (n = 26), bipolar mixed (n = 56), major depressive disorder (MDD) with psychosis (n = 41), MDD without psychosis (n = 10), psychosis (n = 165), schizoaffective disorder (n = 113), and schizophrenia (n = 168). Treatment outcomes of 4 LAIs, Abilify Maintena (AM), Aristada (A), Haldol Decanoate (HD), and Invega Sustenna (IS), were compared using data from the Pharmacy dispensing LAIs tracking log from July 2016 to September 2018. Exclusion criteria included patient refusal for LAI and missed second loading dose of IS injection. The primary objective of the study was to compare the efficacy of LAIs at preventing hospital readmission in <30 days after discharge. Additionally, we examined whether patient diagnosis impacted hospital readmission.
Results: A total of 607 patients who used AM (n=198), A (n=68), HD (n=106), and IS (n=235) during the index hospitalization were analyzed. The IS group had significantly the lowest rate of readmission within 30 days (6.8%, p = 0.028). Logistic regression showed that the likelihood of being readmitted to the hospital within 30 days was 2.1 and 3.2 times higher for patients on AM and A, respectively, compared to patients on IS (OR=2.11, 95% CI=1.07-4.17, p=0.031, and OR=3.16, 95% CI=1.36-7.33, p=0.007). HD group had a lower likelihood of readmission compared to IS, however, there was no significant difference (OR=0.70, 95% CI = 0.232-2.099, p=0.522). There was no statistical difference in readmission <30 days by diagnosis
Conclusion: Among the 4 LAIs compared, IS was the most effective at reducing psychiatric hospital readmission in <30 days. Overall, LAIs are beneficial in preventing hospital readmission in <30 days.