The Research and Evaluation of Antipsychotic Treatment in Community Behavioral Health Organizations, Outcomes (REACH-OUT) study: real-world clinical practice in schizophrenia

BMC Psychiatry. 2018 Jan 29;18(1):24. doi: 10.1186/s12888-018-1594-1.

Abstract

Background: Outpatient facilities, such as community behavioral health organizations (CBHOs), play a critical role in the care of patients with serious mental illness, but there is a paucity of "real-world" patient outcomes data from this health care setting. Therefore, we conducted The Research and Evaluation of Antipsychotic Treatment in Community Behavioral Health Organizations, Outcomes (REACH-OUT) trial, a real-world, prospective, noninterventional observational study of patients with mental illness treated at CBHOs across the United States. We describe demographic and clinical characteristics, antipsychotic therapy (APT) treatment patterns, and health care resource utilization in patients with schizophrenia undergoing medical care as usual.

Methods: This study enrolled adults with schizophrenia or bipolar I disorder who initiated APT treatment at various time points: 1) within 8 weeks of initiating risperidone long-acting injectables (RLAIs) or other APTs except paliperidone palmitate (PP), 2) after more than 24 weeks of continuous RLAI treatment, or 3) at any time after initiating PP LAI treatment (schizophrenia only). Study assessments were performed via participant interview, medical chart abstraction, and clinical survey at enrollment and at month 12.

Results: A total of 1065 patients from 46 CBHOs were enrolled. Of these, 944 (88.6%) had a diagnosis of schizophrenia and 121 (11.4%) had bipolar I disorder. At enrollment, 599 (63.5%) of patients with schizophrenia were receiving RLAIs or PP LAI, 281 (29.8%) were receiving oral APTs, and 64 (6.8%) were receiving other injectable APTs. A number of differences in patient characteristics and outcomes were observed between patients in the LAI APT cohort and the oral APT cohort.

Conclusion: Descriptive analyses from this observational study suggest differences in the patient characteristics, treatment patterns, and clinical and economic outcomes among those with schizophrenia treated at CBHOs with LAI APT or oral APTs. Additional analyses will be conducted to delineate the impact of LAI APT versus oral APTs on patient outcomes.

Trial registration: Clinical Trial Registry: NCT01181960 . Registered 12 August 2010.

Keywords: Antipsychotic therapy; Community behavioral health organizations; Long-acting injectable; Observational study; Paliperidone palmitate; Patient outcomes; Real world; Risperidone long-acting injectable; Schizophrenia.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Ambulatory Care / methods
  • Ambulatory Care / statistics & numerical data
  • Antipsychotic Agents / therapeutic use*
  • Bipolar Disorder / drug therapy*
  • Community Mental Health Services / methods*
  • Community Mental Health Services / statistics & numerical data
  • Delayed-Action Preparations
  • Female
  • Follow-Up Studies
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Paliperidone Palmitate / therapeutic use*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prospective Studies
  • Risperidone / therapeutic use*
  • Schizophrenia / drug therapy*
  • United States

Substances

  • Antipsychotic Agents
  • Delayed-Action Preparations
  • Risperidone
  • Paliperidone Palmitate

Associated data

  • ClinicalTrials.gov/NCT01181960