Combining Medication Adherence Support Plus Long-Acting Injectable Antipsychotic Medication: A Post-Hoc Analysis of 3 Pilot Studies.

Patients with severe mental illness (SMI) who do not adhere to treatment have a lower quality of life, with more hospitalizations, interpersonal relationship conflict, homelessness, substance use problems, and incarceration compared to patients who adhere to treatment. Nonadherence to psychiatric medications has been studied for over a decade in patients diagnosed with bipolar, schizoaffective, and schizophrenia disorders with long-acting injectable antipsychotics (LAI) becoming a mainstay of adherence-focused treatment. Previous studies have shown that LAI treatment can be further optimized with the inclusion of the behavioral intervention, Customized Adherence Enhancement (CAE). It was unclear if outcomes improved similarly across the studies that varied by demographics, diagnoses, and CAE + LAI protocols. We aimed to evaluate CAE + LAI adherence outcomes in SMI by pooling three studies to better understand response to treatment in the setting of varied circumstances. Our findings show that adherence improved similarly across studies despite these differences. Furthermore, it was demonstrated that CAE + LAI improved adherence to a similar degree when primary mood and psychotic disorder cohorts were compared. As the use of LAI expands, our findings show the versatility and effectiveness of including CAE to further optimize adherence and improve other outcomes.

A systematic literature review of health disparities among rural people with epilepsy (RPWE) in the United States and Canada.

BACKGROUND: Epilepsy is a leading cause of global disease burden, with people with epilepsy (PWE) experiencing adverse health outcomes related to the psychiatric comorbidities and socioeconomic consequences of the disorder. Rural populations are more likely to be impoverished or uninsured, which could impact health outcomes for rural-dwelling PWE (RPWE). AIMS: This systematic literature review identified original research studying health disparities and outcomes among RPWE in the United States and Canada to (1) characterize the disparities faced by RPWE and (2) elucidate the effects of these disparities upon clinical outcomes. METHODS: We performed a systematic search of six electronic databases: Pubmed, Cochrane, PsychInfo, Web of Science, Scopus, and Ovid. Articles considered were original research reports conducted in Canada or the United States before August 2020. A modified Newcastle Ottawa Scale was used to assess the quality of the included studies. RESULTS: Our search returned 2093 articles that examined the health disparities of RPWE, of which six met criteria for this review. Outcome measures of health disparity included in these papers were mortality (2; 33%), use of health resources (2; 33%), and epilepsy prevalence (2; 33%). Only one paper (16%) concluded that RPWE experienced worse health outcomes relative to urban-dwelling PWE, while 5 (84%) found no difference. CONCLUSION: Our study did not find sufficient evidence that RPWE in the US and Canada experience significant health disparities compared to similar urban populations of PWE. More research using prospective studies and datasets allowing better characterization of rurality is required.