Category: Federal Forum Posters
Purpose: The timing of long acting injectable (LAI) antipsychotics administration is an important component in the success of patients with psychiatric disorders. The difference between VACCHCS and its neighboring community based outpatient clinics (CBOCs) in the timing of injections was identified as an area in need of assessment. Consistency of practices across the facilities was unknown. This project was designed to determine the effect of timing differences on hospitalizations, emergency room visits, and same day visits. The facilities were also compared to evaluate if assessment of symptoms prior to injections occurred as well.
Methods: In this retrospective cohort review, all veterans receiving LAI antipsychotics for the treatment of schizophrenia and bipolar disorders were reviewed. These included: haloperidol decanoate, paliperidone palmitate, aripiprazole, risperidal, and fluphenazine. The timing of injections was evaluated through review of patient charts and medication administration records from the period of May 2017 to May 2018. Veterans were included if they received at least two doses of a LAI antipsychotic and were excluded if they were on dual LAI antipsychotic therapy. Frequency of injections were evaluated by reviewing provider orders and determining whether the injections were early, late due to scheduling, or late due to patient non-compliance. Each injection encounter was also evaluated to see if assessment of symptoms prior to injection administration occurred. The effect of timing on patient outcomes was measured as hospitalizations, ER visits, or same day clinic visits that were due to either scheduling or non-compliance from the patient. Results were analyzed using descriptive statistics.
Results: A total of 663 injections were given at VACCHCS from May 2017 to May 2018: 80 percent were on time, 9 percent were early, 4 percent were late due to scheduling, and 7 percent were late due to patient non-compliance. A total of 43 injections were given at the Tulare CBOC: 79 percent were on time, 5 percent were early, 5 percent were late due to scheduling, and 12 percent were late due to patient non-compliance. A total of 27 injections were given at the Merced CBOC: 44 percent were on time, 7 percent were early, 4 percent late due to scheduling, and 44 percent were late due to patient non-compliance. There were no injections given at the Oakhurst CBOC. In this review, no hospitalizations, ER or same day visits occurred due to scheduling of LAI antipsychotics. Patient non-compliance resulted in 7 hospitalizations and 4 ER visits at VACCHCS versus 1 hospitalization and 1 ER visit at the Merced CBOC. No hospitalizations or ER visits occurred from the Tulare or Oakhurst CBOCs. Pre-assessment of symptoms occurred 99 percent of the time at VACCHCS, and 0 percent of the time at Merced and Tulare CBOCs.
Conclusion: No numerical differences between the facilities were found in regards to scheduling of injections and effect on patient outcomes. This review identified that the largest effect on outcomes was due to patient non-compliance. Additional reviews are needed to determine any clinical differences between VACCHCS and the CBOCs. The evaluation of symptom burden is an important aspect to consider in this patient population. This review demonstrated that VACCHCS differed from the CBOCs in regard to pre-assessment of symptoms. Moving forward, education and changes in practice may be needed in order to standardize care across the facilities.
Beth Curcin– Pharmacy Resident, VA Central California Health System, Hanford, CA