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Description
INTRODUCTION
Mathari National Teaching and Referral Hospital, in collaboration with AMREF, proposed to start a program to provide a long-acting injectable (LAI) antipsychotic known as Paliperidone palmitate to 50 patients with schizophrenia over a period of 18 months, as a response to the huge gap in management of patients suffering from Schizophrenia. This initiative aims to evaluate the socio-economic performance of the patients before and after participating in the program, with the ultimate goal of generating comprehensive cost-benefit analysis data that will inform national policy on investment in LAI medications and their potential return on investment for National development. This program aims to highlight how a LAI affects various aspects of patients' lives, clinical outcomes, healthcare costs, productivity, and quality of life.
PURPOSE: to generate comprehensive clinical and socioeconomic data to inform national policy on Mental Health Investment.
BACKGROUND
Schizophrenia is one of the most common of the severe mental disorders and is one of the top 25 leading causes of disability worldwide. It is characterized by cognitive, behavioral, perceptual, and emotional dysfunction. The disorder usually begins before the age of 25 years, persists throughout life and affects persons of all socioeconomic classes. This disorder affects not only individuals but also families, caregivers, and societies. Both the patients and their families often suffer from inadequate care, stigma, and financial strain due to the impact of the disorder. Because Schizophrenia usually begins early in life, it causes significant long-lasting impairments, requires ongoing clinical care, rehabilitation, and support services. As a result, the financial cost of the illness is heavy. Indirect costs are also enormous and often underestimated. These include a lack of patient autonomy, caregiver emotional and psychological burden, missing out on employment opportunities for both the patient and the caregiver, reduced productivity of the patient and the caregiver, and overall reduced quality of life of the patient and caregivers.
A LAI antipsychotic is a drug designed to be administered via intramuscular injection at regular intervals, typically every 2 to 12 weeks. It slowly releases the active drug into the bloodstream over an extended period, allowing for consistent therapeutic levels and reducing the need for daily dosing.
METHODOLOGY
To carry out this study, the hospital set up a specialized schizophrenia clinic and medication was provided through collaboration with AMREF. Through this 18-month patient access program, a prospective cohort (n=50) of adults with schizophrenia was selected based on the inclusion criteria. Patients with subclinical outcomes had their regimen reassessed and the LAI administered. Various variables were then measured, including clinical symptom reduction, personal and social performance, direct medical expenditures, patient autonomy and caregiver-burden scales, employment status and workdays, and standardized quality-of-life indices.
The tools used to measure the above variables include Positive and Negative Syndrome Scale (PANSS), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Medication Adherence Report Scale (MARS), World Health Organization Quality of Life (WHO QOL) tool, Personal and Social Performance Scale, and a custom-designed Economic Tool 1 and 2.
FINDINGS
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