What challenges do population health decision makers face when managing patients with schizophrenia? How do they mitigate the barriers?

WWhat challenges do population health decision makers face when managing patients with schizophrenia? What challenges have worsened during the COVID-19 pandemic? What strategies do decision makers recommend to mitigate these challenges? My recent article published in JMCP answers these and other questions.

My recent article titled “Managing the health of the schizophrenia population: perspectives and lessons learned from decision makers on population health” published in JMCP shed light on the current challenges and barriers facing decision makers on the health of the population when treating patients with schizophrenia. This mixed methods research also highlights various strategies to overcome these challenges suggested by population health decision makers.

The summary is below:

BACKGROUND: Despite therapeutic advances for patients with schizophrenia, improving patient outcomes and reducing the cost of care remain a challenge for formulary decision makers.

GOALS: To (1) understand the perspectives of formulary decision makers on the challenges to optimal management of the schizophrenia population and (2) identify best practices and recommendations to mitigate these challenges.

METHODS: This double-blind, mixed-methods study included in-depth telephone interviews with formulary decision makers from February to May 2020, and a web-based follow-up survey sent to all participants in October 2020. USA Formulary-based decision makers were recruited if they were directly involved in schizophrenia drug formulary or coverage decision making for national or regional payers, health systems or facilities behavioral health. The perceptions of the decision makers of the form on the challenges, policies and programs related to the management of the health of the population with schizophrenia were evaluated in general and in the context of the COVID-19 pandemic.

RESULTS: 19 decision makers from the form participated in the interviews and 18 (95%) completed the survey. Participants reported a spectrum of patient- and payer-driven challenges in managing the health of the schizophrenia population, including medication noncompliance, high medical and pharmacy costs, and frequent hospitalizations and visits to the emergency department. Participants noted that COVID-19 had worsened all identified challenges, although patient unemployment (mean score of 2.00 on a scale of 1 (greatly worse) to 5 (greatly improved)) and reduced access to care psychiatric (mean score, 2.12) were the most negatively affected. The most common strategies implemented to improve the health management of the schizophrenia population included case management (89%), telemedicine (83%), care coordination programs (72%), strategies to mitigate barriers to access to medication (61%) and the provision of non-medical services. services to address the social determinants of health (56%). Participants noted that ideally all schizophrenia treatments would be available on their formularies without utilization management policies in place to increase access to medication, but the cost to health plans made this difficult. While 61% of respondents believed that long-acting injectables (LAIs) were currently underused in their organizations, only 28% represented organizations with open access policies for LAIs. Participants believed that among people with schizophrenia, LAIs were most beneficial for those with a history of poor or uncertain adherence to oral medications (mean score of 4.50 on a scale of 1 (not at all beneficial) to 5 (extremely beneficial). ) and those with recurrent emergency department visits and hospital stays (mean score, 3.94). Study participants reported slightly increased use of LAI (mean score of 3.17 on a scale of 1 (negatively impacted) to 5 (positively impacted)) among their patients with schizophrenia in response to the COVID-19 pandemic; 29% of participants reported that they eased access restrictions for LAIs.

CONCLUSIONS: Participants described persistent challenges and various approaches aimed at improving the health management of the schizophrenia population. They also recommended strategies to optimize future health management for this population, including expanding programs to address the social determinants of health and mitigating barriers to accessing treatment.