Category: Professional Posters
Purpose: Schizophrenia is a chronic complex, disability mental illness which is characterized by positive symptoms (delusions, hallucinations and disorganized speech), negative symptoms, and cognitive impairment. Long-acting antipsychotic injection formulations are reserved for patients who prefer this route of administration or when poor adherence is a clinical priority, therefore indicated in the central treatment strategy for the management of schizophrenia. The purpose of this study was to review long-acting antipsychotic injections prescribing trends at Saint Elizabeths Hospital and how they correspond to clinical practice guidelines.
Methods: Using data retrospectively collected from the hospital’s electronic records, patients were identified during the following four months: October 2017 (baseline), May 2018 (study period 1), December 2018 (study period 2), and March 2019 (study period 3). The data collected included the number of patients on long-acting antipsychotic injections (LAIs), the number of LAIs prescribed, the rate per average monthly census, duplicate LAIs details, and total LAIs spending were evaluated. The primary outcome is to decrease the usage of polypharmacy LAIs to one LAI, in order to become 100% compliance based on the recommendation from the pharmacy department per evidence-based clinical guidelines.
Results: The number of patients treated with LAIs was 68 at baseline, 75 in periods 1 and 2, and 66 in period 3. The rates of patients receiving LAIs per average daily census were 24.7% (68/275), 28.9% (75/260), 27.8% (75/270) and 23.9% (66/265) respectively. Eleven patients received duplicate LAIs; 4 at baseline, 5 in period 1, 2 in period 2, and none in period 3. Haloperidol Decanoate and Invega Sustenna were prescribed for 7 patients respectively; haloperidol Decanoate and Risperdal Consta were prescribed for 2 patients respectively; Fluphenazine Decanoate and Invega Sustenna were prescribed for one patient respectively, and; Fluphenazine Decanoate and Risperdal Consta were prescribed for 1 patient respectively. None of the patients received more than two LAIs during the same treatment period. Polypharmacy LAI prevalence was 1.5% (4/275) at baseline, 1.9% (5/260) in period 1, 0.7% (2/270) in period 2, and 0% in period 3. Total LAI purchasing in 2018 decreased from 2017 ($1.14 million versus $1.37 million). Considering the inflation rate of 9.6%, an estimated $364,167 in cost savings was achieved by implementing new guidance on LAIs.
Conclusion: This pharmacist quality improvement DUE lead to a collaboration between the Pharmacy and Therapeutic Committee and the Psychiatry team in developing, implementing, and monitoring the use of LAIs, therefore it yielded a dramatic change in the prevalence of polypharmacy and total spending. Almost 25% of Saint Elizabeths Hospital patients were treated with LAIs during the study period and implementation of new guidance and continued monitoring resulted in estimated cost savings of $364,167 in the past year.