Use of risperidone long-acting injectable in a rural border community clinic in southern california.
BACKGROUND
The rate of medication nonadherence among patients with chronic psychiatric conditions, such as schizophrenia and bipolar disorder, has been estimated to be between 40 and 60 percent. Poor adherence leads to clinical deterioration and increased disability in this population. Additionally, it adds to the burden cost of providing mental health services in underserved rural areas. Long-term injectable antipsychotics are considered a valuable tool to counteract medication nonadherence.


OBJECTIVE
To describe the level of adherence and functioning among a group of patients, the majority of which were Hispanic, receiving risperidone long acting injectable (RLAI) in a community clinic in a border area of rural southern California.


METHODS
A retrospective chart review was conducted from January, 2005, though December, 2006, of patients receiving RLAI, looking at adherence to their scheduled appointments and improvement in their global assessment of functioning (GAF).


RESULTS
Fifty patients with schizophrenia and bipolar disorder were reviewed. Thirty-four received RLAI for at least one year, seven for at least six months, and seven for at least three months. For patients receiving RLAI, there was a significant improvement in patient adherence with appointments. Their no-show rate improved from 27 to 15 percent. Similar improvement was found for those patients receiving RLAI for six and three months. For those patients receiving RLAI for one year, their GAF improved from a mean of 40.8 to 57.2 (standard deviation [SD]=12.39, df=33, p<0.01). Similar improvement was found in those receiving RLAI for six months (mean GAF improvement from 36.4 to 51.8 [SD=9.7, df=6, p<0.01]) and three months (mean GAF improvement from 40.7-60.4 [SD=13.8, df=6, p<0.01]).


CONCLUSIONS
Adherence among our group of majority Hispanics with disabling psychiatric conditions (schizophrenia and severe bipolar disorder) improved when they participate in a RLAI clinic with active case management. A longitudinal follow-up study is needed to determine improvement of their quality of life, comorbid substance use, and metabolic outcomes, and to evaluate long-term remission of symptoms among this specific population.
Camacho
Alvaro
A
Drs. Camacho and Ng are with the Imperial County Behavioral Health, El Centro, California, the Sun Valley Research Center, Imperial, California, and the Department of Psychiatry. University of California, San Diego.
Ng
Bernardo
B
Galangue
Barbara
B
Feifel
David
D