Are Clinician Misperceptions the Biggest Barrier to LAI Use?

A prescriber’s confidence and consistency in offering long-acting injectable (LAI) antipsychotic therapy likely affects a patient’s willingness to try it, according to a poster presented at the Psych Congress NP Institute Annual Meeting in San Diego, California.

“Many patients prefer LAIs, especially after they’ve given them a try,” wrote author Craig Chepke, MD, DFAPA.

The poster summarized published findings about the underutilization of LAI antipsychotics in patients with schizophrenia. In one study, less than a fifth of US psychiatrists surveyed said they prescribed LAIs to patients with poor adherence to oral antipsychotics. Another study estimated that less than 10% of patients with schizophrenia in treatment receive LAI antipsychotics.

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A survey of 302 psychiatrists and 77 psychiatric nurse practitioners and physician assistants in the United States identified several perceived barriers to LAIs, including needle aversion, insurance coverage, and patient perceptions that use of a LAI antipsychotic reflects disease severity. In reality, patient attitudes about LAIs are usually positive, the poster pointed out. A study in France showed a preference for injections among 206 patients who had received LAI antipsychotic treatment for 3 months or more.

The biggest barrier to patient use may be clinician attitudes toward LAIs, the poster suggested. Dr Chepke referenced an analysis of 33 psychiatrist conversations with patients that showed that the modality (“injection,” “shot’) was the emphasis in 91% of the talks. Just 9% of the conversations focused on the benefits of long-acting therapy.

Not surprisingly, two-thirds of patients declined the offer of an LAI. However, during a post-visit interview that probed patients’ feelings about medications, 96% of patients who turned down the initial offer said they would be willing to try a LAI antipsychotic after all.

“Clinician willingness to offer them consistently and their confidence in approaching the discussion may be the limiting factors in their adoption,” Dr Chepke advised.

Reference

Chepke C. Examining the underutilization of LAIs in schizophrenia. Poster presented at NP Institute Annual Meeting; March 20-23, 2024; San Diego, California