Effective Communication Strategies for Introducing LAIs in Telemedicine Settings

In this video, filmed at the 2025 Psych Congress NP Institute in Orlando, Florida, Psych Congress Scientific Director Craig Chepke, MD, DFAPA, discusses effective communication strategies clinicians can use when introducing long-acting injectable (LAI) antipsychotics to patients for the treatment of schizophrenia. Dr Chepke provides guidance on the language and framing that can best resonate with patients who may be hesitant to use injectable treatments. He also emphasizes how clinicians in telehealth settings can ensure patients have access to these treatments regardless of their location.

For more expert insights for your virtual practice, visit the Telehealth Excellence Forum here on Psych Congress Network.

Read the Transcript

Craig Chepke, MD, DFAPA: Hi, my name is Craig Chepke. I’m a psychiatrist in private practice at Excel Psychiatric Associates in Huntersville, North Carolina. I’m also an adjunct associate professor of psychiatry for Atrium Health in Charlotte, North Carolina, and the scientific director for the Psych Congress event portfolio.

Psych Congress Network: What communication strategies have you found most effective—especially in telemedicine settings—when introducing LAIs to patients who may be hesitant?

Chepke: When it comes to the use of LAIs in people living with schizophrenia, it's communication, communication, communication. First, we have to think about the shared decision-making process and really offering the patient all the different options. We almost always need to apply some motivational interviewing. One thing that I think is important is that we need to be mindful of how we're presenting the information. Of course, we're going to present all the information that is relevant for efficacy, safety, and tolerability. But the order we present it in is very important. 

For instance, if we come straight out and use that LAI term, and say, “I want to talk to you about a long-acting injectable,” the amygdala of the patient’s brain hears the word, “injection,” and goes, "Red alert, red alert, don't like shots,” and then the patient’s brain turns off to any of the other attributes we may talk about. So, I don't hide that these are injections by nature, but I don't put that first. I save that for later on in the conversation. 

I first say [to the patient], “What about a long-acting treatment, something that you wouldn't have to take every day? What if you only had to take your medicine once a month with the potential to take it only every 2 months, every 3 months, maybe even every 6 months?” I do flip—I will talk about monthly LAIs as once a month, but then after that, I often flip it around to, “What if you only had to take your medication 6 times a year? What about only 4 times a year? What about just 2 times every year?” Something about the psychology of saying, “6 times a year” seems more palatable to people than to say, “every other month.” 

A patient might think, “Every other month, jeez, I don't want to take a shot every other month. But I could probably do 6 times a year taking an injection.” My anecdotal experience suggests that it's more palatable that way. And sometimes I will say “12 times a year” for monthly injections, but I don't find it being more favorable—it’s kind of hit or miss and depends on my relationship with the individual and what I think they're going to resonate with the best. But talking about reducing the pill burden, not having to think about the medication as much, that it's got a more stable and consistent blood concentration, those types of advantages. Then, usually, the patient is interested because who wants to take a pill 365 times a year? Literally no one. So that is opening the door. 

Then we talk about some of the other aspects of the LAIs, like the blood concentrations being more stable and reliable. Eventually, once a patient shows interest, I’ll say, “Now let's talk about some of the potential side effects and other considerations.” We'll talk about the side effects, which are usually molecule-based, but I will also bring up that an LAI is given by injection in the muscle, either in the arm or in the hip, depending on the individual LAI, or if it's a subcutaneous one, it could be in the abdomen, the back of the arm, places of that nature. With employing that approach, it tends to work a lot better so that by that point they're willing to consider the LAI when, in my opinion, if I'd have brought up the word “injection” or “injectable” or “shot” early on, they may have just completely shut the conversation down. 

When someone is interested in LAIs, I want to pounce on it. If they already have established oral tolerability, I'll give them the first injection that day. If not, then of course we do have to give them a period of oral tolerability with the medication in oral form, but this is a little bit harder when entailed by telemedicine. Because if a patient is in my clinic, I almost always have samples in my sample closet. I can just go and grab one and give them the injection right then and there to get started. But over telemedicine, it introduces a delay. Often, the people that we're seeing over telemedicine may be because they live in a rural area that's farther away, or it's harder to get into the office as frequently. 

What we can leverage is that in almost every state of the US, pharmacists have the ability to administer LAIs. Usually, it's with us as the prescriber writing a prescription that’s filled at the pharmacy, but a pharmacist can give the injections in almost all 50 states of the US at this point—I think there's only 2 or 3 states where it's not able to be done currently, but that number goes down every year or so. If there is a pharmacy that's right around the block from the patient, I can have the LAIs sent there. Then their pharmacist, whom they might know very well and have a long-term relationship with and trust, can give them the injection. Sometimes, though, I still try to get them to come back into my office if they don't have a great relationship with the pharmacist. It does introduce a little bit of challenge to prescribe LAIs over telemedicine, but absolutely nothing that's insurmountable. 

I think we should be offering LAIs to every person living with schizophrenia, whether it's the first break or their 20th hospitalization, and whether they're in our office or they're hours away in the same state, but over a telemedicine connection. 

I want to thank you for watching this video today. I urge you to check back here for more practical and actionable updates, which I hope is what you got from today's videos.

Craig Chepke, MD, DFAPA, is a board-certified psychiatrist in clinical practice as the medical director of Excel Psychiatric Associates in Huntersville, NC, and is an Adjunct Associate Professor of Psychiatry for the Sandra and Leon Levine Psychiatry Residency Program at Atrium Health. Dr Chepke is the scientific director for the Psych Congress portfolio of CME conferences, and he has been recognized as a Distinguished Fellow of the American Psychiatric Association.