(P-355) Polypharmacy and Outpatient Attendance of People with Schizophrenia in Indonesia

Background: The use of polypharmacy in schizophrenia is prevalent in Indonesia. However, the pattern of polypharmacy and its impacts on outpatient attendance were unknown.

Objectives: To explore the polypharmacy pattern in schizophrenia treatment and the impacts of polypharmacy on outpatient attendance of patients with schizophrenia in Indonesia.

Methods: This was a retrospective longitudinal study exploring data from medical records (n=378) sourced from a psychiatric hospital in Indonesia from January to June 2019. The outcome variable is outpatient attendance. Since outpatient appointments were usually made once per month - per Indonesian national insurance regulation - the outpatient attendance was based on whether patients fulfilled the appointment at the corresponding month. The predictor variables were gender; age; job type; marital status; education attainment; schizophrenia type; number, type, and the dose of prescribed medicines; distance to the hospital; and payment type. The association between each variable and outpatient attendance was modeled using the generalized estimating equation. Two multivariate models were developed. In the first model, the number of prescribed medicines was added as one of the predictors. In the second model, the aforementioned variable was substituted by two variables: the level of antipsychotics use in defined daily dose (DDD)/patient/day and the number of adjuvant medicines. The statistical significance level was set at 0.05.

Results: The use of antipsychotic polypharmacy was related to outpatient attendance. In the first multivariate model, two variables related to attendance were the number of prescribed medicines (for every addition of one medicine, odds ratio 1.33, 95% confidence interval 1.09-1.61, p<0.01) and national insurance coverage (vs. out-of-pocket, 1.73, 1.10-2.71, p<0.01). In the second model, attendance was related to the level of antipsychotic use (for every increase in one DDD/patient/day, 1.44, 1.04-1.99, p<0.05), the number of adjuvant medicines (1.26, 1.02-1.56, p<0.05), and national insurance coverage (1.64, 1.04-2.58, p<0.05). Although 72.8% of patients received two or more antipsychotics, more than half were prescribed below 1.0 DDD/patient/day. The use of antipsychotics, notably atypical ones, was limited by the Indonesian insurance body. Thus using a second antipsychotic may be needed to control symptoms.

Conclusions: Outpatient attendance was related to polypharmacy and insurance coverage. The use of polypharmacy may be related to the insurer’s restriction.