Recommendations Aimed at Improving Schizophrenia Population Health Management, Care Coordination Policies

By Julie Gould

Carmela Benson, director, real world value & evidence, Janssen Scientific Affairs, LLC, discusses recent research that examined Schizophrenia Population Health Management (SPHM) among adults in order to better understand how population health decision makers (PHDMs) prioritize and respond to challenges in schizophrenia population health management.  

Why did you conduct this study? What existing data prompted this investigation

Within our Janssen Real World Value & Evidence Team, we analyze patient-level data from various sources. Through our research on schizophrenia care and management in adults, we consistently find that, compared to oral antipsychotics, long-acting injectable (LAI) antipsychotics are associated with a number of clinical and economic benefits for adult patients and the health care system. An example includes delaying time to relapse, which has been found to contribute to lower health care resource utilization and cost as patients are less often hospitalized when their schizophrenia symptoms are effectively managed.

We believe adults living with schizophrenia deserve better treatment outcomes. We’ve also observed that oral antipsychotics are the most prevalent treatment in the market, despite the increased availability and benefits of LAIs. So, in order to understand this divide, we wanted to better understand how PHDMs prioritize and respond to challenges in schizophrenia population health management. This had not been clearly explored in existing literature. The findings were presented at the Academy of Managed Care Pharmacy (AMCP) 2021 Annual Meeting (see F11—Understanding Schizophrenia Population Health Management: A Mixed-Methods Study With US Population Health Decision Makers).

As we were developing the questionnaire for the follow-on survey, the COVID-19 pandemic created new, and exacerbated existing, challenges faced by adult schizophrenia patients in managing their disease. We included COVID-related questions to pinpoint how the utilization of behavioral health care resources were impacted during this time, and how PHDMs have adapted to ensure continued quality treatment and support for patients. We presented these particular findings at the College of Psychiatric and Neurologic Pharmacists (CPNP) Annual Meeting 2021 (abstract linked here—Understanding the Impact of COVID-19 on Schizophrenia Population Health Management: A Mixed-Methods Study of Population Health Decision Makers).   

Can you talk about your study and the related findings? Were you surprised by any of the outcomes?

We conducted a double-blind mixed-methods study of nineteen PHDMs at national or state-level payers, health systems, or behavioral health organizations in two phases: (1) in-depth, semi-structured interviews conducted by telephone between February – May 2020, and (2) a web-based follow-on survey sent to all participants in October 2020, to refine and quantify observations from the interviews and assess the impact of the COVID-19 pandemic on current practices.

During the interview phase, PHDMs ranked the top challenges impacting schizophrenia population health management, which included medication non-adherence (83%), high medical costs (72%), frequent emergency department (ED) visits (61%), frequent hospitalizations (56%) and high pharmacy costs (56%). PHDMs perceived benefit of LAIs aligned with current clinical guideline recommendations, including the use of LAIs in adult patients with difficultly adhering to medication, and for adult patients with schizophrenia relapse resulting in ED visits and inpatient stays. Interestingly, while 61% of respondents believed that LAIs were currently underused, only 28% of represented organizations that promoted open access policies to LAIs.

As part of the follow-on survey, PHDMs indicated that the COVID-19 pandemic has positively impacted telehealth programs (mean=4.06 on a 1-5 scale, 1 =‘negatively impacted,’ 3 =‘no impact,’ and 5 =‘positively impacted’) and the use of long acting injectable antipsychotics.

It is also important to note that overall, PHDMs perceived that COVID-19 had little to no impact on medical or pharmacy costs (mean=2.89 on a 1-5 scale, 1 =‘much worse,’ 3 =’no impact,’ and 5 =‘much better’), but negatively impacted social determinants of health, including unemployment (mean=2.00), social support (mean=2.28), food insecurity (mean=2.33), as well as access to psychiatric care (mean=2.11).

What are the possible real-world applications of these findings in clinical practice?

The pandemic has exacerbated socioeconomic challenges faced by adults living with schizophrenia, and the survey findings indicate that PHDMs have an opportunity to help patients identify and access the right level of care. This may include educating treatment providers about the value of LAIs, as part of the schizophrenia treatment options available for appropriate adults.

Do you hope to expand upon this research?

We focused on PHDMs who are managing the adult schizophrenia patient population as a whole. Future areas of interest may include: 1) studying PHDMs who are directly involved in patient care; 2) understanding if/how PHDM perceptions or behaviors have changed post-COVID, and the longer-term impacts (if any) on schizophrenia population health management.

Is there anything else pertaining to your research and findings that you would like to add?

We will be sharing additional data gathered across the two study phases that we plan to publish later this year. 

About Ms Benson

Carmela Benson is currently the Director of Real World Value & Evidence, Neuroscience (Schizophrenia), at Janssen Scientific Affairs, LLC. She received her MSc in Health Policy from the Thomas Jefferson University, School of Population Health, and my Master of Statistics from the University of the Philippines. As an outcomes researcher, Ms Benson has worked across a number of therapeutic areas where she has evaluated the impact and value of various medicines, delivery care models, and health policies.  

Reference:

Lin D, Roach M, Graf M, Pednekar P, Benson C, Chou J, Doshi J. Understanding schizophrenia population health management: a mixed-methods study with us population health decision makers. Poster presented at: AMCP 2021, April 12-16, 2021; Virtual.