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Paliperidone palmitate is one of the most widely prescribed long-acting injectable (LAI) antipsychotics in the UK. However, it is relatively expensive and there are few data comparing its effectiveness to that of other LAI antipsychotics. We sought to address this issue by analyzing a large anonymized electronic health record (EHR) dataset from patients treated with LAI antipsychotics.
EHR data were obtained from 1281 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who started treatment with a LAI antipsychotic between 1 April 2011 and 31 January 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were analyzed in each of the 3 years before and after LAI prescription.
Patients treated with paliperidone palmitate (n = 430; 33.6%) had a greater number of inpatient days and a greater number of admissions in the year prior to treatment than those treated with other LAI antipsychotics. Nevertheless, in the 3 years after initiation there were no significant differences between paliperidone and the other LAI antipsychotics in the number of days as an inpatient (B coefficient 5.4 days, 95% confidence interval (CI) −57.3 to 68.2, p = 0.86) or number of hospital admissions (Incidence rate ratio 1.07, 95% CI 0.62 to 1.83, p = 0.82).
Paliperidone palmitate was more likely to be prescribed in patients with more frequent and lengthy hospital admissions prior to initiation. However, the absence of differences in outcomes after initiation indicates that paliperidone palmitate was not more effective than other cheaper LAI antipsychotics.
Studies indicate that risk of mortality is higher for patients admitted
to acute hospitals at the weekend. However, less is known about clinical
outcomes among patients admitted to psychiatric hospitals.
To investigate whether weekend admission to a psychiatric hospital is
associated with worse clinical outcomes.
Data were obtained from 45 264 consecutive psychiatric hospital
admissions. The association of weekend admission with in-patient
mortality, duration of hospital admission and risk of readmission was
investigated using multivariable regression analyses. Secondary analyses
were performed to investigate the distribution of admissions, discharges,
in-patient mortality, episodes of seclusion and violent incidents on
different days of the week.
There were 7303 weekend admissions (16.1%). Patients who were aged
between 26 and 35 years, female or from a minority ethnic group were more
likely to be admitted at the weekend. Patients admitted at the weekend
were more likely to present via acute hospital services, other
psychiatric hospitals and the criminal justice system than to be admitted
directly from their own home. Weekend admission was associated with a
shorter duration of admission (B coefficient –21.1 days,
95% CI –24.6 to –17.6, P<0.001) and an increased risk
of readmission in the 12 months following index admission (incidence rate
ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but
in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23,
P = 0.30) was not greater than for weekday admission.
Fewer episodes of seclusion occurred at the weekend but there was no
significant variation in deaths during hospital admission or violent
incidents on different days of the week.
Being admitted at the weekend was not associated with an increased risk
of in-patient mortality. However, patients admitted at the weekend had
shorter admissions and were more likely to be readmitted, suggesting that
they may represent a different clinical population to those admitted
during the week. This is an important consideration if mental healthcare
services are to be implemented across a 7-day week.