Research and Evaluation of Antipsychotic Treatment in Community Behavioral Health Organizations

The purpose of this study is to build a data repository that can be used to understand pharmaceutical utilization patterns among patients being treated in community behavioral health organizations (CBHOs) for schizophrenia or bipolar I disorder.

Study Overview

• Status: Completed
• Conditions: Schizophrenia; Bipolar Disorder
• Intervention / Treatment: Drug: Risperidone long acting injectable - New Starts; Drug: Risperidone long acting injectable - Continuous Users; Drug: Paliperidone Palmitate -New and Continuous Users; Drug: Other Antipsychotics - New Starts

Detailed Description

This is a prospective observational study of usual care of patients undergoing treatment for schizophrenia or bipolar I disorder at CBHOs. Up to 50 CBHOs will be selected as sites for this study. Treating clinicians at these sites will notify the designated research coordinators for this study when they are initiating a patient on a new antipsychotic medication (including risperidone long acting injectable or paliperidone palmitate) or if they are treating a patient with risperidone long acting injectable or paliperidone palmitate. New initiation will include patients not previously on any antipsychotic medication as well as those switched from one antipsychotic to another. Switches may include but are not limited to switches among different types of oral antipsychotics, from an oral antipsychotic to Long Acting Therapy (LAT), or from LAT to an oral antipsychotic. Site research staff will screen potential participants identified by the clinicians and enroll those meeting study criteria who consent to study participation. Sites will maintain a screening log of all potential participants. The target enrollment for this study is up to 2,450 participants. Enrollment by cohort will be monitored and sites will be notified to stop enrollment if target enrollment for a particular cohort has been reached. Eligible participants who consent to the study will be recruited into one of two samples: participants with a schizophrenia diagnosis (target n=2,250) and participants with a bipolar I disorder diagnosis (target n=200). There will be four cohorts: risperidone long acting injectable new starts (target n=475); risperidone long acting injectable continuous users (target n=75); paliperidone palmitate new starts or continuous users (target n=1,200); and other antipsychotic new starts (target n=700). During the entire study follow-up period participants will receive their medication per usual care in their treatment setting and no study drug will be provided. Enrolled participants will be followed prospectively over a 12-month study period, with interviews at baseline, 6 and 12 months. Sites will also abstract medical history and healthcare utilization information from the chart of each enrolled participant. There will be three chart abstractions (baseline, 6 Months, 12 Months). The baseline abstraction will cover services rendered in the 6 months prior to antipsychotic initiation or switch, or from their first visit to the CBHO if the individual did not receive services for as long as 6 months prior to initiation or switch. The 6M and 12M abstractions will each cover services rendered in the prior 6 months. When all three abstractions are complete, the data will cover the period from 6 months before baseline to 12 months after baseline. If a Serious Adverse Event (SAE) associated with a J&J medicinal product occurs the investigator will record it in the source document as well as fax the SAE form to J&J internal safety group within 24 hours. Treatment as usual

• Study Type: Observational
• Enrollment (Actual): 1066

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Bullhead City, Arizona, United States, 86442
      • Neuropsychiatry Clinic and Research Center
  • California
    • Colton, California, United States, 92324
      • Shanti Clinical Trials
    • Imperial, California, United States, 92251
      • Sun Valley Research Center
    • Norwalk, California, United States, 90650
      • South Coast Clinical Trials, Inc.
  • Colorado
    • Aurora, Colorado, United States, 80014
      • Aurora Mental Health Center
  • Florida
    • Leesburg, Florida, United States, 34749
      • LifeStream Behavioral Center, Inc.
    • Miami, Florida, United States, 33165
      • APF Research
  • Georgia
    • Macon, Georgia, United States, 31217
      • River Edge Behavioral Health Center
  • Illinois
    • Peoria, Illinois, United States, 61603
      • Human Service Center (Fayette Companies)
    • Springfield, Illinois, United States, 62794
      • Southern Illinois University School of Medicine
  • Indiana
    • Bloomington, Indiana, United States, 47401
      • Centerstone-Indiana Centerstone Research Institute
  • Louisiana
    • Baton Rouge, Louisiana, United States, 70808
      • Medical Development Centers LLC (Baton Rouge)
    • Opelousas, Louisiana, United States, 70570
      • Medical Development Centers LLC (Opelousas)
  • Michigan
    • Farmington Hills, Michigan, United States, 48331
      • OCCMHA/Community Network Services, Inc.: Oakland County Community Mental Health Authority
    • Grand Rapids, Michigan, United States, 49503
      • Cherry Street Health Services
  • Missouri
    • Sikeston, Missouri, United States, 63801
      • Bootheel Counseling Services
    • Springfield, Missouri, United States, 65804
      • Burrell Behavioral Health
    • St. Louis, Missouri, United States, 63128
      • CenterPointe Institute of Research
  • Nebraska
    • Lincoln, Nebraska, United States, 68526
      • Premier Psychiatric Research Institute
  • New Hampshire
    • Manchester, New Hampshire, United States, 03101
      • The Mental Health Center of Greater Manchester
  • New Jersey
    • Paramus, New Jersey, United States, 07652
      • Bergen Regional Medical Center
    • Paterson, New Jersey, United States, 07503
      • St Joseph's Regional Medical Center
  • North Carolina
    • Durham, North Carolina, United States, 27705
      • Carolina Behavioral Care - Durham [CAREMARK]
    • Henderson, North Carolina, United States, 27536
      • Carolina Behavioral Care - Henderson
    • Hillsborough, North Carolina, United States, 27278
      • Carolina Behavioral Care - Hillsborough
  • Pennsylvania
    • Allentown, Pennsylvania, United States, 18103
      • Lehigh Valley Hospital Dept. of Psychiatry
    • Pittsburgh, Pennsylvania, United States, 15238
      • Family Services of Western Pennsylvania
    • Uniontown, Pennsylvania, United States, 15401
      • Chestnut Ridge Counseling Services, Inc.
  • Rhode Island
    • Charleston, Rhode Island, United States, 02813
      • South Shore Mental Health Center
    • Pawtucket, Rhode Island, United States, 61603
      • Human Service Center (Fayette Companies)
  • Tennessee
    • Nashville, Tennessee, United States, 37228
      • Centerstone-Tennessee Centerstone Research Institute
  • Texas
    • Arlington, Texas, United States, 76016
      • Institute for Health Evaluation and Research Unlimited [IHEARU]
    • San Antonio, Texas, United States, 78229
      • Center for Health Care Services
  • Washington
    • Spokane, Washington, United States, 99204
      • Frontier Institute-Research Department for Spokane Mental Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 64 years (ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Potential participants will be identified by treating clinicians at the site. The study will enroll participants treated at participating sites for schizophrenia and bipolar I disorder. The study does not involve administration of a study drug, but will naturalistically follow partticipants in these medication cohorts at the time of enrollment: clinician ordered initiation or switch to LAT within past 4 weeks, clinician ordered initiation or switch to oral antipsychotic within past 4 weeks, continuous users ( greater than or equal to 6 months) of Risperdal long acting injectable, continuous users (greater than or equal to 1 month) of Invega Sustenna.

Description

Inclusion Criteria:

• Diagnosed with schizophrenia or bipolar I disorder
• Antipsychotic use in one of the following categories: Clinician ordered initiation of Risperidone long acting injectable in the 4 weeks prior to or on the day of enrollment (includes patients not previously on any antipsychotic medication and those switched from another antipsychotic)
• On continuous Risperidone long acting injectable for at least 6 months prior to enrollment (no gaps between injections>30 days)
• Clinician ordered initiation of Paliperidone Palmitate in the 4 weeks prior to or on the day of enrollment (includes patients not previously on any antipsychotic medication and those switched from another antipsychotic)
• or on continuous Paliperidone Palmitate for any time period prior to enrollment
• Clinician ordered initiation of another antipsychotic in the 4 weeks prior to or on the day of enrollment (includes patients not previously on any antipsychotic medication and those switched from another antipsychotic)
• Not enrolled in another clinical study
• Primary source of care for schizophrenia or bipolar I disorder is the recruiting CBHO
• Agrees to all study procedures/interviews
• must sign the study informed consent document indicating that they understand the purpose of and procedures required for the study and are willing to participate in the study

Exclusion Criteria:

• Currently participating in a clinical study (e.g. clinical trial or observational study) or participated in a clinical study within the past 30 days

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
001; Risperidone long acting injectable - New Starts Patients who switch to Risperidone long acting injectable or receive an initial injection of Risperidone long acting injectable within the 30 days prior to enrollment will be eligible for inclusion in the Risperidone long acting injectable New Starts cohort.	Drug: Risperidone long acting injectable - New Starts; Patients who switch to Risperidone long acting injectable or receive an initial injection of Risperidone long acting injectable within the 30 days prior to enrollment will be eligible for inclusion in the Risperidone long acting injectable New Starts cohort.
002; Risperidone long acting injectable - Continuous Users Patients who have been on Risperidone long acting injectable for at least 6 months before baseline with no gaps between injections of more than 30 days will be eligible for inclusion in the Risperidone long acting injectable Continuous Users cohort.	Drug: Risperidone long acting injectable - Continuous Users; Patients who have been on Risperidone long acting injectable for at least 6 months before baseline, with no gaps between injections of more than 30 days will be eligible for inclusion in the Risperidone long acting injectable Continuous Users cohort.
003; Paliperidone Palmitate -New and Continuous Users Patients newly initiating Paliperidone Palmitate or on Paliperidone Palmitate at the time of enrollment	Drug: Paliperidone Palmitate -New and Continuous Users; Patients newly initiating Paliperidone Palmitate or on Paliperidone Palmitate at the time of enrollment
004; Other Antipsychotics - New Starts Participants in the other antipsychotic cohort may be newly started on any oral or injectable antipsychotic other than Risperidone long acting injectable and Paliperidone Palmitate	Drug: Other Antipsychotics - New Starts; Participants in the other antipsychotic cohort may be newly started on any oral or injectable antipsychotic other than Risperidone long acting injectable and Paliperidone Palmitate

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The number of psychiatric hospitalizations, non-psychiatric hospitalizations, emergency room visits, and CBHO visits.	Up to 12 months.

Secondary Outcome Measures

Outcome Measure	Time Frame
Demographic and related participant information	Baseline, 6 and 12 months
The Structured Clinical Interview for Symptoms of Remission (SCI-SR) will be used to assess remission among participants with schizophrenia.	Baseline, 6 and 12 months
Quality of life will be measured using a modified version of the brief version of Lehman's Quality of Life Interview (QOLI). Developed specifically for use with persons with serious mental illness, and assesses satisfaction.	Baseline, 6 and 12 months
Psychiatric clinical characteristics will include the age first hospitalized for schizophrenia or bipolar I disorder (as applicable), or the years since first diagnosis.	Baseline, 6 and 12 months
The Personal and Social Performance Scale (PSP) will be used to measure functioning in four key areas: socially useful activities, including work and study; personal and social relationships; self -care; and disturbing behaviors.	Baseline, 6 and 12 months

Collaborators and Investigators

• Sponsor: Janssen Scientific Affairs, LLC

Publications and helpful links

General Publications

• Joshi K, Mao L, Biondi DM, Millet R. The Research and Evaluation of Antipsychotic Treatment in Community Behavioral Health Organizations, Outcomes (REACH-OUT) study: real-world clinical practice in schizophrenia. BMC Psychiatry. 2018 Jan 29;18(1):24. doi: 10.1186/s12888-018-1594-1.

Study record dates

Study Major Dates

• Study Start: August 1, 2010
• Primary Completion (ACTUAL): November 1, 2013
• Study Completion (ACTUAL): November 1, 2013

Study Registration Dates

• First Submitted: August 12, 2010
• First Submitted That Met QC Criteria: August 12, 2010
• First Posted (ESTIMATE): August 13, 2010

Study Record Updates

• Last Update Posted (ESTIMATE): February 12, 2014
• Last Update Submitted That Met QC Criteria: February 11, 2014
• Last Verified: February 1, 2014

More Information

Terms related to this study

• Keywords: Risperdal Consta; Paliperidone Palmitate; Invega Sustenna; Risperidone long acting injectable
• Additional Relevant MeSH Terms: Mental Disorders; Schizophrenia Spectrum and Other Psychotic Disorders; Bipolar and Related Disorders; Schizophrenia; Bipolar Disorder; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Central Nervous System Depressants; Tranquilizing Agents; Psychotropic Drugs; Serotonin Agents; Dopamine Agents; Serotonin 5-HT2 Receptor Antagonists; Serotonin Antagonists; Dopamine D2 Receptor Antagonists; Dopamine Antagonists; Paliperidone Palmitate; Risperidone; Antipsychotic Agents
• Other Study ID Numbers: CR017107; RIS-OUT-239 (OTHER: Janssen Scientific Affairs, LLC)