Colorado Springs, CO — The use of very long-performing injectable (LAI) antipsychotic therapy alternatively of oral medicines for schizophrenia is linked with demographic and scientific factors was instructed by a single-center, retrospective cohort study.
younger age (OR .97, 95% CI .95-.99, P.=.01) predicted which clients acquired LAI antipsychotic procedure, reported Emily Groenendaal, MD, New York Clinical College, Valhalla.
Duration of initial medical center continue to be also predicted LAI use (OR 1.06, 95% CI 1.03-1.09, P.<0.001), Groenendaal said in a presentation at the 2022 Neuroscience Education Institute Conference.
Patients receiving LAI treatment had more severe disease and longer initial hospital stay (LAI group 23.0 days vs. oral group 13.0 days P.<0.001) and a higher proportion of complex secretions (LAI group 30.1% vs oral group 6.5%, P.<0.001), says Groenendaal.
It is likely that neither cost nor socioeconomic status influenced these findings, as more than 90% of the patient population had public insurance and there were no differences between groups in terms of insurance status. she pointed out.
“There were many direct indicators of disease severity,” Groenendaal said. MedPage Today“For example, the most commonly found in the literature is the length of initial hospital stay. Longer lengths of stay in an inpatient ward are a direct indicator of increasing disease severity. Was it set up? Something more intensive than just outpatient care.”
“Starting with the predictors, we found that younger age and longer hospital stay were the only predictors of receiving LAI,” she said. This was good because it shows that the higher the severity of the disease, i.e. the more severe the medication is, the more difficult the medication adherence should always be to receive the LAI. We are moving in the direction of reducing the course of the disease.”
The researchers also analyzed predictors of patients using first- or second-generation antipsychotics (LAI or oral). Older age was a significant predictor of first-generation LAI use, and this group was more likely to have a comorbid substance use disorder, they reported.
For first- and second-generation oral antipsychotics, first-generation oral therapy was more likely to be used in older, female patients. Patients using first-generation oral therapy were more likely to have complex discharges and longer initial hospital stays.
Groenendaal said providers of older patients on first-generation antipsychotics, especially those with well-controlled symptoms, were reluctant to switch them to second-generation antipsychotics. said it is possible.
“We found that older age was actually a significant predictor when it came to receiving a first-generation LAI, because the first generation can generally have more instances of EPS. , which is not very appropriate. [extrapyramidal symptoms] Or movement disorders,” said Groenendaal.
To identify predictors, Groenendaal and co-authors collated medical records of 246 patients diagnosed with schizophrenia or schizoaffective disorder in 2019 at the Westchester Medical Center Health System in Valhalla, New York. .
This cohort was diagnostically concordant between patients receiving LAI antipsychotics (n=123) and patients receiving oral antipsychotics (n=123). All sociodemographic and clinical factors, including indices of disease severity, were collected from patients’ medical records.
The findings highlight several revelations about institutional prescribing patterns for this patient population and have sparked a conversation about how decisions are made when prescribing LAIs or oral antipsychotics to patients. , Groenendaal pointed out.
For critically ill patients, LAI may be the best choice, but we are educators. [and] We absolutely need to present patients with all the options and help them make choices,” she said.