Barriers to Long-acting Injectable Antipsychotic Adherence During the COVID-19 Pandemic: Observations From One Site

Abstract

Objective: Long-acting injectable antipsychotics (LAI-As) are a crucial treatment option for individuals with serious mental illness. However, due to the necessity of in-person administration of LAI-As, pandemics pose unique challenges for continuity of care in the population prescribed these medications. This project investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic on LAI-A adherence at a Veterans Health Administration medical facility in the United States, as well as changes in LAI-A prescribing and administration practices during this period. Methods: Electronic health records were evaluated for 101 patients prescribed LAI-As. A subset of 13 patients also participated in an interview and rated subjective concerns about pandemic-related barriers to medication adherence. Results: Pandemic-related barriers to LAI-A adherence and/or changes to LAI-A medications were documented in 33% of the patients. Within-subjects comparison of an adherence metric computed from electronic health record data further suggested a somewhat higher incidence of missed or delayed LAI-A doses during the pandemic compared with before the pandemic. In contrast, only 2 of the 13 patients interviewed anticipated that pandemic-related concerns would interfere with medication adherence. Conclusions: The results of this study suggest that LAI-A access and adherence can be disrupted by pandemics and other public health emergencies but this finding may not generalize to other sites. As patients may not foresee the potential for disruption, psychiatric service providers may need to assist in proactively problem-solving barriers to access. Improved preparedness and additional safeguards against pandemic-related disruptions to LAI-A access and adherence may help mitigate adverse outcomes in the future. Identifying patients at elevated risk for such disruptions may help support these efforts.

Long‐acting injectable antipsychotics as maintenance therapy for schizophrenia during the COVID‐19 pandemic: A micro‐narrative review

“…We identified several studies using parameter changes related to LAIs during the COVID‐19 pandemic (Table 3). These studies highlighted that LAIs treatment was associated with the risk of infection, limited clinic access, and increased frequency of LAIs non‐adherence during the COVID‐19 pandemic 12,13 . To counter these issues, strategies such as switching to oral medications 12,14,15 and less frequent LAIs administration 12,15,16 were adopted.…”

“…These studies highlighted that LAIs treatment was associated with the risk of infection, limited clinic access, and increased frequency of LAIs non‐adherence during the COVID‐19 pandemic. 12 , 13 To counter these issues, strategies such as switching to oral medications 12 , 14 , 15 and less frequent LAIs administration 12 , 15 , 16 were adopted. Other infection control measures included home visits 12 and LAIs administration at community pharmacies.…”

Lessons from the coronavirus disease 2019 pandemic in schizophrenia: a review

“…The prescription of long-acting injectable antipsychotics (LAI) has been a challenge in many countries with various results [44][45][46][47][48][49][50][51][52][53][54][55]. In the United States, Canada, Italy, and Greece, no significant increase of LAI disruption has been identified in electronic records [25,44,45,53].…”