A Qualitative Study of Experiences with and Perceptions regarding Long-Acting Injectable Antipsychotics: Part I—Patient Perspectives

Abstract

Despite the well-acknowledged problem of poor adherence to antipsychotic (AP) medication, long-acting injectables (LAIs) that could improve adherence are underused in Canada. Attitudes concerning LAIs among patients and psychiatrists may contribute to this underuse. Our objective was to investigate perceptions of and attitudes toward LAIs among patients in Canada. Method: Focus groups were conducted with 34 patients with a diagnosis of schizophrenia spectrum psychoses in 4 Canadian provinces. The focus groups inquired about experiences with and attitudes toward LAI APs. The sessions were audiotaped and transcribed verbatim, and transcripts were coded using a combination of deductive and inductive methods. Results: Four themes emerged: awareness of and knowledge about LAIs; perceptions about LAIs; cost and convenience considerations; and issues arising from the coercive context under which LAIs were often prescribed. Nine patients had never heard about LAIs, and some others reported not having understood what was discussed with them regarding LAIs. Patients had typically heard about LAIs in either a context of coercion or of medication nonadherence. Patients had positive and negative perceptions concerning LAIs. The positive perceptions centred on relapse prevention and reduced effort in ensuring adherence, and the negative perceptions centred on financial costs and the inconvenience of appointments to receive injections. Conclusion: To enhance LAI usage, some of the issues that need to be addressed are the inadequacy of information given to patients, the element of coercion involved in LAI introduction, the pragmatic barriers to LAI uptake by patients, and negative subjective perceptions about LAIs.

Clinical benefits and impact of early use of long‐acting injectable antipsychotics for schizophrenia

“…These limitations may contribute to poor attitudes by patients and prescribers towards LAIs and act as barriers to wider and earlier use. 54,85 In addition, barriers to administering LAIs in the community psychiatric setting, such as lack of training for administering injectable drugs, are impediments to broader use of LAIs. 86 A need exists for randomized controlled trials (RCTs) of an adequate duration with LAIs in firstepisode schizophrenia including trials comparing LAIs with oral medication.…”

The effects of switching from oral to LAI antipsychotic treatment on subjective experience of schizophrenic and schizoaffective patients: Preliminary results

“…Similarly, while the benefi ts of second-generation over fi rst-generation antipsychotics (SGA vs FGA) (Crossley et al 2010;Leucht et al 2013) and of long-acting injectable over oral (LAI vs oral) antipsychotic formulations (Ju et al 2014;Kaplan et al 2013;Lafeuille et al 2013;Rauch and Fleischhacker 2013) in terms of better effi cacy, prevention of relapse, tolerability, and drug kinetics and dynamics have been widely demonstrated, less research have been devoted to the evaluation of the subjective impact of switching antipsychotic administration from oral to LAI (Iyer et al 2013;Kaplan et al 2013;Kirschner et al 2013;Rosa et al 2012).…”

The use of long-acting injectable antipsychotic medication

“…Several studies have demonstrated that LAIs are welcomed by patients or even preferred (Walburn et al 2001, Phillips and McCann 2007, Iyer et al 2013, Das et al 2014) with at least one study suggesting an unfavourable view (Patel et al 2010). In situations where patients express an unfavourable view of LAIs, this may be because they have not been fully informed of LAIs as a treatment option.…”