Skip to main content

Abstract

Objective:

The authors designed this project to identify barriers to using long-acting formulations of antipsychotics.

Methods:

The authors used a focused ethnographic approach. Patients, psychiatrists, nurses, therapists and administrators were interviewed about barriers to use of long-acting injectable (LAI) antipsychotics at six facilities in New York State, as were representatives from insurance firms, a pharmaceutical company, and a national professional organization. Interviews were conducted and analyzed by a central team not affiliated with the institutions.

Results:

Interviews were obtained with 23 patients, 16 psychiatrists, three nurses, 23 therapists, 14 administrators, four insurers, one representative from a pharmaceutical industry, and one representative from a national organization. Major barriers identified from the interviews included restricting discussions about LAI medication to only patients with nonadherence or repeated hospitalizations; inadequate education efforts with patients about LAI antipsychotics; inadequate support for patients making medication decisions; lack of communication within the treatment team about issues relevant to use of LAI formulations by patients; therapists’ limited knowledge about LAI antipsychotics, which restricted their role in supporting patients making treatment decisions; psychiatrist concerns about the pharmacologic properties of LAI formulations; lack of clinic infrastructure to support LAI prescriptions; and payer concerns about whether the immediate costs of LAI administration would translate into later potential cost benefits.

Conclusions:

Effective shared decision making about use of LAI antipsychotics requires that patients receive accurate information and support for their decision making. The training needs and administrative support requirements of all team members should be considered to provide patients with the information and support required.

Formats available

You can view the full content in the following formats:

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 337 - 342
PubMed: 31847736

History

Received: 9 May 2019
Revision received: 13 September 2019
Accepted: 17 October 2019
Published online: 18 December 2019
Published in print: April 01, 2020

Keywords

  1. Antipsychotics
  2. Long-acting injectable antipsychotics
  3. Schizophrenia
  4. Antipsychotics/economics
  5. Patient physician communication
  6. Attitudes of health personnel

Authors

Details

Delbert G. Robinson, M.D. [email protected]
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna).
Anant Subramaniam, M.A.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna).
Paul J. Fearis, M.A.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna).
Richard Shi, B.S.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna).
Megan Walsh, M.A, M.B.A.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna).
Lauren A. Hanna, M.D.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna).
John M. Kane, M.D.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Robinson, Kane); Feinstein Institute for Medical Research, Manhasset, New York (Robinson, Kane); Becton Dickinson, Baltimore (Subramaniam); Department of Biomedical Engineering, Duke University, Durham, North Carolina (Fearis); New York Medical College, Valhalla (Shi); Zucker Hillside Hospital, Glen Oaks, New York (Walsh, Hanna).

Notes

Send correspondence to Dr. Robinson ([email protected]).

Competing Interests

Dr. Robinson has been a consultant to Costello Medical Consulting, Innovative Science Solutions, Janssen, Neurocrine, Neuronix, Otsuka, and US WorldMeds. Mr. Subramaniam, Mr. Fearis, and Mr. Shi are former employees of Clinvue. Dr. Kane has been a consultant for or received honoraria from Alkermes, Eli Lilly, EnVivo Pharmaceuticals (Forum), Forest (Allergan), Genentech, H. Lundbeck, Intracellular Therapies, Janssen Pharmaceutica, Johnson and Johnson, Merck, Neurocrine, Newron, Otsuka, Pierre Fabre, Reviva, Roche, Sumitomo, Sunovion, Takeda, and Teva. Dr. Kane has also received grant support from Otsuka, H. Lundbeck, and Janssen Pharmaceutica. Dr. Kane is a shareholder in Vanguard Research Group and LB Pharmaceuticals. The other authors report no financial relationships with commercial interests.

Funding Information

This work was supported by Centers for Medicare and Medicaid Services grant CMS-1L1-15-003.

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

View Options

View options

PDF/EPUB

View PDF/EPUB

Full Text

View Full Text

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Purchase Options

Purchase this article to access the full text.

PPV Articles - Psychiatric Services

PPV Articles - Psychiatric Services

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share