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 resulte...
| Main Authors: | , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Oxford University Press
2016
|
| _version_ | 1797095236450648064 |
|---|---|
| author | Rezansoff, S Moniruzzaman, A Fazel, S McCandless, L Procyshyn, R Somers, J |
| author_facet | Rezansoff, S Moniruzzaman, A Fazel, S McCandless, L Procyshyn, R Somers, J |
| author_sort | Rezansoff, S |
| collection | OXFORD |
| description | 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). |
| first_indexed | 2024-03-07T04:24:58Z |
| format | Journal article |
| id | oxford-uuid:cc4ce235-c555-4553-bdde-b61db3b06d45 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T04:24:58Z |
| publishDate | 2016 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:cc4ce235-c555-4553-bdde-b61db3b06d452022-03-27T07:20:57ZHousing first improves adherence to antipsychotic medication among formerly homeless adults with schizophrenia: results of a randomized controlled trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:cc4ce235-c555-4553-bdde-b61db3b06d45EnglishSymplectic Elements at OxfordOxford University Press2016Rezansoff, SMoniruzzaman, AFazel, SMcCandless, LProcyshyn, RSomers, JAdherence 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). |
| spellingShingle | Rezansoff, S Moniruzzaman, A Fazel, S McCandless, L Procyshyn, R Somers, J Housing first improves adherence to antipsychotic medication among formerly homeless adults with schizophrenia: results of a randomized controlled trial |
| title | Housing first improves adherence to antipsychotic medication among formerly homeless adults with schizophrenia: results of a randomized controlled trial |
| title_full | Housing first improves adherence to antipsychotic medication among formerly homeless adults with schizophrenia: results of a randomized controlled trial |
| title_fullStr | Housing first improves adherence to antipsychotic medication among formerly homeless adults with schizophrenia: results of a randomized controlled trial |
| title_full_unstemmed | Housing first improves adherence to antipsychotic medication among formerly homeless adults with schizophrenia: results of a randomized controlled trial |
| title_short | Housing first improves adherence to antipsychotic medication among formerly homeless adults with schizophrenia: results of a randomized controlled trial |
| title_sort | housing first improves adherence to antipsychotic medication among formerly homeless adults with schizophrenia results of a randomized controlled trial |
| work_keys_str_mv | AT rezansoffs housingfirstimprovesadherencetoantipsychoticmedicationamongformerlyhomelessadultswithschizophreniaresultsofarandomizedcontrolledtrial AT moniruzzamana housingfirstimprovesadherencetoantipsychoticmedicationamongformerlyhomelessadultswithschizophreniaresultsofarandomizedcontrolledtrial AT fazels housingfirstimprovesadherencetoantipsychoticmedicationamongformerlyhomelessadultswithschizophreniaresultsofarandomizedcontrolledtrial AT mccandlessl housingfirstimprovesadherencetoantipsychoticmedicationamongformerlyhomelessadultswithschizophreniaresultsofarandomizedcontrolledtrial AT procyshynr housingfirstimprovesadherencetoantipsychoticmedicationamongformerlyhomelessadultswithschizophreniaresultsofarandomizedcontrolledtrial AT somersj housingfirstimprovesadherencetoantipsychoticmedicationamongformerlyhomelessadultswithschizophreniaresultsofarandomizedcontrolledtrial |