Use of Long-Acting Injectable Antipsychotic in an Inpatient Unit of a Community Teaching Hospital

Abstract

Background Individuals with Schizophrenia Spectrum Disorders (SSD) often experience significant impairment in educational, occupational, and psychosocial functioning. The clinical benefit of long-acting injectable antipsychotics (LAIs) in the management of patients with SSD is well established. SSD patients who are nonadherent to treatment have lower disease relapse and readmission rates when prescribed a LAI, compared to oral antipsychotics. Despite the reported advantages of LAIs, their prescription rates in clinical settings remain low. This pilot study aimed to determine the pattern of LAI prescription in psychiatric inpatients of a teaching community hospital in Brooklyn, New York. Methods A retrospective review of the charts of patients discharged from the psychiatric units of the hospital from September 1, 2017, through September 30, 2017, was conducted. Frequencies and proportions for demographic and disease-related characteristics were calculated. Pertinent continuous variables were recoded into categorical variables. Chi-square-tests or Fisher's exact tests were performed for categorical variables. The one-sample Shapiro-Wilk test (for sample size < 50) was used to check for the normality of distribution of continuous variables. Statistical significance was defined as p ≤ 0.05. Results Forty-three (70%) of the patients discharged from the inpatient unit during the study period had SSD and were eligible for a LAI. Their ages ranged from 20 to 71 years (mean = 41 years), and more than two-thirds were male. Less than half of the eligible patients (n = 19; 44%) were prescribed a LAI, most of whom were male (n=16; 84%). An association between age group (patients aged 41 years or younger) and LAI use was observed (p < 0.05), while gender, employment status, living arrangement, length of hospital stay, recent hospitalization, and cooccurring substance use disorder were not. Conclusion LAI prescription rate at the inpatient psychiatric unit of the hospital was marginally higher than those reported in most studies. Age appears to influence LAI use during the study period. Initiatives that increase LAI prescription rate for all eligible patients admitted to inpatient psychiatric unit should be encouraged.