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Adherence to Antipsychotics Among Latinos and Asians With Schizophrenia and Limited English Proficiency

Dr. Gilmer and Dr. Ojeda are affiliated with the Department of Family and Preventive Medicine, University of California, San Diego (UCSD), 9500 Gilman Dr., La Jolla, CA 92093-0622 (e-mail: tgilmer{at}ucsd.edu). Dr. Barrio and Ms. Fuentes are with the School of Social Work, University of Southern California, Los Angeles. Dr. Garcia is with San Diego County Adult and Older Adult Mental Health Services. Dr. Lanouette is with the Department of Psychiatry and Dr. Lee is with the Skaggs School of Pharmacy and Pharmaceutical Sciences, both at UCSD. Data from this study were presented at the Health Services Research Meeting of the National Institute of Mental Health, Washington, D.C., July 23, 2007, and the Critical Research Issues in Latino Mental Health Conference, Santa Fe, New Mexico, March 10–12, 2008.

OBJECTIVES: The authors examined data for 7,784 Latino, Asian, and non-Latino white Medi-Cal beneficiaries with schizophrenia to determine the relationship between patients' preferred language for mental health services—English, Spanish, or an Asian language—and their adherence to treatment with antipsychotic medications. METHODS: Data reflected 31,560 person-years from 1999 to 2004. Pharmacy records were analyzed to assess medication adherence by use of the medication possession ratio (MPR). Clients were defined as nonadherent (MPR<.5), partially adherent (MPR=.5–<.8), or adherent (MPR=.8–1.1) or as an excess filler of prescriptions (MPR<1.1). Regression models were used to examine adherence, hospitalization, and costs by race-ethnicity and language status. RESULTS: Latinos with limited English proficiency were more likely than English-proficient Latinos to be medication adherent (41% versus 36%; p<.001) and less likely to be excess fillers (15% versus 20%; p<.001). Asians with limited English proficiency were less likely than English-proficient Asians to be adherent (40% versus 45%; p=.034), more likely to be nonadherent (29% versus 22%; p<.001), and less likely to be excess fillers (13% versus 17%; p=.004). When analyses controlled for adherence and comorbidities, clients with limited English proficiency had lower rates of hospitalization and lower health care costs than English-proficient and white clients. CONCLUSIONS: Adherence to antipsychotic medications varied by English proficiency among and within ethnic groups. Policies supporting the training of bilingual and multicultural providers from ethnic minority groups and interventions that capitalize on patients' existing social support networks may improve adherence to treatment in linguistically diverse populations.

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