Patient and prescriber perspectives on long-acting injectable (LAI) antipsychotics and analysis of in-office discussion regarding LAI treatment for schizophrenia

BMC Psychiatry

Gina Lau³  Donna Zubek³  Rimal Bera¹  Steven Potkin² 

[1] School of Medicine, Irvine, University of California, Bldg 3-Rt 88, 101 The City Drive, Mail Code: 1680, Orange, CA 92668, USA;Department of Psychiatry and Human Behavior, University of California, Irvine, School of Medicine, Irvine, California, 5251 California Avenue, Suite 240, Irvine, CA 92697-3960, USA;Otsuka America Pharmaceutical Inc, 1 University Square Drive, Suite 500, Princeton, NJ 08540, USA

关键词: Ethnographic;    Depot antipsychotics;    Psychiatrists attitudes;    Patient attitudes;    Office-visit discussions;    Community mental health;    Treatment benefits;    Schizophrenia;    Prescriber perspectives;    Patient perspectives;    Long-acting injectable antipsychotics;   

Others  :  1123933
DOI  :  10.1186/1471-244X-13-261

 received in 2013-03-26, accepted in 2013-09-26,  发布年份 2013

【 摘 要 】

Background

The research goal is to better understand prescriber, patient, and caregiver perspectives about long-acting injectable (LAI) antipsychotic therapy and how these perspectives affect LAI use. Addressing these perspectives in the clinic may lead to greater success in achieving therapeutic goals for the patient with schizophrenia.

Methods

Ethnographic information was collected from a non-random sample of 69 prescriber-patient conversations (60 with community mental health center [CMHC] psychiatrists; 9 with nurse-practitioners) recorded during treatment visits from August 2011 to February 2012, transcribed and analyzed. Discussions were categorized according to 11 predetermined CMHC topics. In-person observations were also conducted at 4 CMHCs, including home visits by researchers (n = 15 patients) prior to the CMHC visit and observations of patients receiving injections and interacting with staff. Telephone in-depth interviews with psychiatrists, patients, and caregivers to gather additional information on LAI discussion, prescription, or use were conducted.

Results

Antipsychotic treatment decisions were made without patient or caregiver input in 40 of 60 (67%) of psychiatrist-patient conversations. Involvement of patients or caregivers in treatment decisions was greater when discussing LAI (15 of 60 [25%]) vs oral antipsychotic treatment (5 of 60 [8%]). LAIs were not discussed by psychiatrists in 11 of 22 (50%) patients taking oral antipsychotics. When offered, more LAI-naïve patients expressed neutral (9 of 19 [47%]) rather than favorable (3 of 19 [16%]) or unfavorable (7 of 19 [37%]) responses. Prescribers were most concerned about potentially damaging the therapeutic relationship and side-effects when discussing LAIs while patient resistance was often related to negative feelings about injections. Psychiatrists had some success in overcoming patient objections to LAIs by addressing and decomposing initial resistance. More than half (11 of 19 [58%]) of LAI-naïve patients agreed to start LAI treatment following office visits. Patient-described benefits of LAIs vs orals included perceived rapid symptom improvement and greater overall efficacy.

Conclusions

In this study, many psychiatrists did not offer LAIs and most patients and caregivers were not involved in antipsychotic treatment decision making. Opportunities to increase active patient engagement, address resistances, guide patient drug-formulation selection, and provide better LAI-relevant information for more individualized approaches to treating the patient with schizophrenia were present.

【 授权许可】

   
2013 Potkin et al.; licensee BioMed Central Ltd.

【 图 表 】

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