Community management: An effective model to reduce medication discontinuation rate in patients with schizophrenia

Abstract

Background Medication discontinuation is highly prevalent among patients with schizophrenia and is associated with poor clinical outcomes. Although community-based management models have been implemented in China to support patients, recent evidence of their effectiveness in reducing medication discontinuation rates remains limited. Methods In this cross-sectional study, we surveyed 1,531 patients with schizophrenia under community management in Chengdu, China, using a multi-stage sampling approach. Data on treatment discontinuation (defined as cessation of all antipsychotics for >15 days without medical advice), socio-demographics, clinical characteristics, and service utilization were collected via face-to-face interviews. Univariate and multivariable logistic regression analyses were used to identify the factors associated with medication discontinuation. Results The overall rate of medication discontinuation was 4.1%. Multivariable analysis identified several independent risk factors for discontinuation: weak stable disease state (adjusted odds ratio [aOR] = 2.70, 95% confidence interval [CI]: 1.34–5.24), lack of insight (aOR for partial vs. no insight = 0.25, 95% CI: 0.08–0.80; aOR for full vs. no insight = 0.18, 95% CI: 0.05–0.65), presence of noticeable side effects (aOR = 1.98, 95% CI: 1.05–3.64), and absence of regular follow-up (aOR for intermittent vs. no follow-up = 0.38, 95% CI: 0.20–0.72; aOR for regular vs. no follow-up = 0.22, 95% CI: 0.10–0.44). Conclusion Community management was associated with a low rate of medication discontinuation in patients with schizophrenia. Key modifiable factors, including disease stability, insight, medication side effects, and follow-up adherence should be prioritized in community-based interventions to further improve treatment continuity.