Management of Schizophrenia Spectrum Disorders in the Outpatient Setting: A Quality Improvement Project

Antipsychotic medications are the basis for treatment of schizophrenia spectrum disorders. Despite symptom improvement with antipsychotic medications for these patients, nonadherence to medications persists which may lead to symptom reoccurrence, decreased quality of life, and increased rates of rehospitalization. The aim of this quality improvement project was to determine, through a retrospective analysis, factors impacting treatment adherence in an outpatient setting in Central Florida for patients with a schizophrenia spectrum disorder enrolled in a patient assistance program to identify gaps in care/services in order to improve quality care. Data were collected using convenience sampling from an electronic health record at an outpatient clinic. Logistic regression was used to identify any possible correlations between personal and social factors related to treatment adherence. Lack of life skills coaching, insurance, utilization of decanoate medications, and side effects decreased the likelihood of stability at the last visit. Significant odds of instability at the last visit was 27% higher for clients with a substance abuse history. While medication nonadherence remains a challenge in patients diagnosed with schizophrenia spectrum disorders, several components of care appeared to positively influence treatment outcomes. Quality improvement recommendations based on identified gaps were made to improve medication nonadherence in practice.