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Background <p>Long-acting injectable antipsychotics (LAIs) reduce relapses in schizophrenia; however, most clinicians reserve LAIs for nonadherence with oral antipsychotics (OAs) or severe disease.</p> Methods <p>US psychiatric clinicians were surveyed regarding their schizophrenia management practices and use of LAIs. Respondents were grouped by LAI use (high [≥ 31% of patients using LAIs], low [≤ 14% using LAIs]; mid not analyzed) and mindset based on their response to “Which of the following best fits the current way you view your use of [LAIs] for your patients with schizophrenia?”</p> Results <p>Respondents (<i>n =</i> 380) were distributed across LAI use (106 high, 130 low) and mindset (123 early-use, 88 severity-reserved, 113 adherence-reserved, 56 LAI-hesitant) subgroups. Across subgroups, clinicians estimated that OA nonadherence was lower for patients in their practice (21–52%) than for patients nationwide (50–56%). Compared with other subgroups, greater proportions with high LAI use or an early-use mindset were confident in key aspects of LAI treatment like dosing, managing side effects, and access (67–74% high LAI use, 59–70% early-use vs. 11–57% other subgroups; <i>P</i> &lt; .05 each), agreed it was “worth [their] time to resolve issues with the insurance company” (42%, 45% vs. 16–30%; <i>P</i> &lt; .05 each), and were optimistic they would be able to do so (23%, 20% vs. 2–11%; <i>P</i> &lt; .05 each). Clinicians with high LAI use estimated the proportion of patients who initially accept LAIs to be higher (mean, 56%) than clinicians with low LAI use (45%, <i>P</i> &lt; .01); there were no differences among mindsets (49–54%). Clinicians with high LAI use or early-use mindset were more likely to “use any means necessary to ensure that a patient is on an LAI” than clinicians in other subgroups (44% high LAI use, 51% early-use vs. 5–22% other subgroups; <i>P</i> &lt; .01 each) or had used guardianship to assist with treatment (70%, 69% vs. 32–56%; <i>P</i> &lt; .05 each).</p> Conclusions <p>These results indicate that multiple factors (e.g., environmental/demographic factors, access, attitudes, motivation, knowledge/confidence) combine to influence LAI use, and highlight the need to tailor educational materials aimed at improving patient outcomes through increased LAI use.</p> Graphical abstract <p></p>

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Clinician differences in attitudes and perceptions on the use of long-acting injectable antipsychotic agents in treating patients with schizophrenia: results from the US DECIDE survey

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月11日

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  • Dawn Velligan,
  • Gregory D. Salinas,
  • Emily Belcher,
  • Kelli R. Franzenburg,
  • Mark Suett,
  • Stephen Thompson,
  • Rolf T. Hansen III

摘要

Background

Long-acting injectable antipsychotics (LAIs) reduce relapses in schizophrenia; however, most clinicians reserve LAIs for nonadherence with oral antipsychotics (OAs) or severe disease.

Methods

US psychiatric clinicians were surveyed regarding their schizophrenia management practices and use of LAIs. Respondents were grouped by LAI use (high [≥ 31% of patients using LAIs], low [≤ 14% using LAIs]; mid not analyzed) and mindset based on their response to “Which of the following best fits the current way you view your use of [LAIs] for your patients with schizophrenia?”

Results

Respondents (n = 380) were distributed across LAI use (106 high, 130 low) and mindset (123 early-use, 88 severity-reserved, 113 adherence-reserved, 56 LAI-hesitant) subgroups. Across subgroups, clinicians estimated that OA nonadherence was lower for patients in their practice (21–52%) than for patients nationwide (50–56%). Compared with other subgroups, greater proportions with high LAI use or an early-use mindset were confident in key aspects of LAI treatment like dosing, managing side effects, and access (67–74% high LAI use, 59–70% early-use vs. 11–57% other subgroups; P < .05 each), agreed it was “worth [their] time to resolve issues with the insurance company” (42%, 45% vs. 16–30%; P < .05 each), and were optimistic they would be able to do so (23%, 20% vs. 2–11%; P < .05 each). Clinicians with high LAI use estimated the proportion of patients who initially accept LAIs to be higher (mean, 56%) than clinicians with low LAI use (45%, P < .01); there were no differences among mindsets (49–54%). Clinicians with high LAI use or early-use mindset were more likely to “use any means necessary to ensure that a patient is on an LAI” than clinicians in other subgroups (44% high LAI use, 51% early-use vs. 5–22% other subgroups; P < .01 each) or had used guardianship to assist with treatment (70%, 69% vs. 32–56%; P < .05 each).

Conclusions

These results indicate that multiple factors (e.g., environmental/demographic factors, access, attitudes, motivation, knowledge/confidence) combine to influence LAI use, and highlight the need to tailor educational materials aimed at improving patient outcomes through increased LAI use.

Graphical abstract