Attitudes and perceptions about the use of long-acting injectable antipsychotics among behavioral health practitioners

Abstract

Introduction Long-acting injectable antipsychotics (LAI-As) are important tools for the treatment of schizophrenia, yet they appear to be underutilized. This study will assess practitioner perceptions of LAI-As to elucidate reasons for underuse and uncover new avenues to increase appropriate use. Methods An anonymous electronic survey was developed and actively distributed to behavioral health care practitioners (MD, DO, PA, NP, PharmD, RN, LCSW). Independent t testing and linear regression analysis was used to assess for interactions between survey responses and individual factors. Results A total of 146 survey responses were collected from September 3, 2020 to March 17, 2021. On average, participants thought that LAI-As were slightly underutilized in practice. The mean estimated patient acceptance rate for LAI-A therapy was 38.6% ± 29.5% (range = 0%-100%). Participants who were <40 years of age and those with a psychiatric pharmacist at their practice site had significantly higher estimated acceptance rates. The highest-rated barriers to LAI-A use were related to negative patient attitudes, lack of patient education, and access issues (eg, transportation, cost). Respondent characteristics including age, gender identity, geographic location, practice setting, and the presence of a psychiatric pharmacist significantly influenced the perceived impact of these barriers. Discussion Behavioral health practitioners generally believed that LAI-As were underused, and only one-third of their patients would be accepting of the therapy. Several barriers were perceived as frequently impacting LAI-A use, but these were reduced by the presence of a psychiatric pharmacist. Understanding practitioner perceptions can assist with increasing the use of LAI-As.

Cumulative Clinical Experience of the Use of Paliperidone Palmitate 3-Monthly Long-Acting Injection in the Treatment of Schizophrenia: A Critical Appraisal

“…Two randomised clinical trials recorded an 8.8% and 8.1% relapse rate, respectively, in patients with schizophrenia during their first year of treatment with PP3M. 17 , 41 A recent naturalistic multicentre study, however, reported a somewhat higher rate of relapse (18.5%) after 1 year of treatment with PP3M in a cohort of 178 patients from Canada, 48 although this difference, could be due to the fact that only patients with a diagnosis of schizophrenia were enrolled in the RCTs, while the naturalistic patient cohort also included patients diagnosed with other comorbid mental disorders, such as substance misuse and personality disorders. In fact, when the patients with psychiatric comorbidity were excluded from the analysis, the relapse rate dropped to 9.7%, which was similar to the one reported by the RCTs.…”

“…16 Incongruously, while the use of chronic injectable medication is a well-regarded treatment tool by both clinicians and patients, in other areas of medicine usage of long acting-injectables antipsychotics in psychiatry remains a topic of ongoing debate and controversy. [17][18][19] Be that as it may, pharmacokinetic and pharmacodynamics studies in the last decades have shown that, particularly the newer LAIs, improve drug delivery, regular plasma concentrations and dosing precision reducing the risk of overdose. 20 Moreover, a number of clinical studies and systematic reviews including a recent large meta-analysis of 137 studies (32 RCTs, 65 cohort and 40 pre-post studies) demonstrated that LAIs significantly reduce the risk of hospital admissions and relapses compared to oral antipsychotics in patients with schizophrenia 21 while beneficial effects of LAIs have also been reported in patients with other psychotic disorders, such as schizoaffective and bipolar disorders.…”

Effectiveness and Safety of Switching from Oral Antipsychotics to Once-Monthly Paliperidone Palmitate (PP1M) in the Management of Schizophrenia: A Systematic Review and Meta-Analysis

“…For various reasons, approximately one-third of patients with schizophrenia did not adhere to their OAP treatment regimen [ 5 ]. To improve adherence, long-acting injectable antipsychotics (LAI) were proposed as an effective tool [ 6 ], although they remain underutilised in clinical practice [ 7 , 8 ]. Several studies suggested LAIs may offer an advantage in increasing patient adherence and reducing relapse and rehospitalisation when compared with OAPs [ 9 – 11 ].…”