Transitions of care: Assessment of adherence to long-acting injectable antipsychotic treatment following discharge from inpatient psychiatry

Abstract

Introduction: Long-acting injectable antipsychotics (LAI-APs) are used in patients with chronic psychiatric disorders as a strategy to manage oral medication nonadherence. Inpatient LAI-AP administration may assist with transition to the outpatient setting. The study objective was to characterize receipt of the next LAI-AP injection as planned in the outpatient setting following administration during inpatient psychiatric hospitalization. Methods: Patients 18 years and older were eligible for inclusion if they received an LAI-AP while inpatient and provided consent to monitor their 90-day follow-up. The primary outcome determined the percentage of patients who received the same LAI-AP administered during their inpatient psychiatric admission at their initial visit post discharge. The secondary outcomes compared appropriate documentation of the LAI-AP follow-up plan, oral overlap, and early psychiatric rehospitalization rates. Results: Fifty-one patients were included. Twenty-nine patients (56.9%) followed up within the outpatient setting after discharge and received their next scheduled LAI-AP as planned. Twenty-two patients (43.1%) did not receive an LAI-AP injection following discharge, 15 of whom did not attend their initial follow-up appointment. Thirty-nine patients (76.5%) were newly initiated on LAI-AP therapy, 19 of whom received their next follow-up injection. Discussion: More than 40% of patients who received an LAI-AP inpatient did not follow up in the outpatient setting despite appropriate discharge planning. Patients more likely to receive follow-up LAI-AP were older, received a maintenance injection while inpatient, and had a scheduled follow-up appointment. Prior to inpatient administration of LAI-AP, multiple factors should be considered, including outpatient adherence, access, feasibility of outpatient continuation, and transition of care plan.

Keywords

• long-acting injectable antipsychotics
• antipsychotics
• prospective
• bipolar disorder
• schizophrenia