Housing First Improves Adherence to Antipsychotic Medication Among Formerly Homeless Adults With Schizophrenia: Results of a Randomized Controlled Trial.
Adherence to antipsychotic medication is a significant challenge among homeless patients. No experimental trials have investigated the impact of Housing First on adherence among patients with schizophrenia. We investigated whether Housing First in congregate and scattered-site configurations resulted in superior adherence compared to usual care. Adult participants (n = 165) met criteria for homelessness, schizophrenia, and initiation of antipsychotic pharmacotherapy prior to recruitment to an unblinded, 3-arm randomized controlled trial in Vancouver, Canada. Randomization arms were: congregate Housing First (CHF) with on-site supports (including physician and pharmacy services); scattered-site Housing First (SHF) with Assertive Community Treatment; or treatment as usual (TAU) consisting of existing services. Participants were followed for an average of 2.6 years. Adherence to antipsychotic medication was measured using the medication possession ratio (MPR), and 1-way ANOVA was used to compare outcomes between the 3 conditions. Data were drawn from comprehensive pharmacy records. Prior to randomization, mean MPR among participants was very low (0.44-0.48). Mean MPR in the follow-up period was significantly different between study arms (P < .001) and approached the guideline threshold of 0.80 in SHF. Compared to TAU, antipsychotic adherence was significantly higher in SHF but not in CHF. The results demonstrate that further implementation of SHF is indicated among homeless people with schizophrenia, and that urgent action is needed to address very low levels of antipsychotic adherence in this population (trial registration: ISRCTN57595077).
Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Stefanie N
SN
Rezansoff
Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Akm
A
Moniruzzaman
Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
Seena
S
Fazel
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Lawrence
L
McCandless
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
Ric
R
Procyshyn
Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Julian M
JM
Somers
D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D001955:British Columbia; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011638:Public Housing / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000188:drug therapy* / Q000534:rehabilitation*; D016903:Drug Monitoring
D014150:Antipsychotic Agents
Assertive Community Treatment; homelessness; medication possession ratio
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