Attitude and preferences towards oral and long-acting injectable antipsychotics in patients with psychosis in KwaZulu-Natal, South Africa

Abstract

Background: Patient attitudes to and satisfaction with their treatment are associated with improved adherence. There is a paucity of data on patient drug attitudes and preference to oral compared to long-acting injectable (LAI) antipsychotic treatment.Aim: To describe patients attitudes and preferences towards oral versus LAI antipsychotic formulations and explore factors associated with their drug attitudes.Setting: Two psychiatric hospitals in KwaZulu-Natal, South Africa.Method: A cross–sectional survey of 140 adult outpatients with schizophrenia spectrum disorders receiving LAI with or without oral antipsychotics (a total of 70) were compared to patients receiving oral antipsychotics only (N = 70). A sociodemographic-clinical questionnaire, chart review and the Drug Attitude Inventory scale (DAI–30) were used.Results: Of the 140 participants, 98 (70%) preferred the medication formulation currently prescribed, and 132 (94.3%) reported a positive drug attitude towards their antipsychotic medication. The adjusted regression analysis indicated that study participants who were currently on a formulation that matched their preference scored better on the DAI-30 than individuals with a mismatch in use and preference (p 0.04). In terms of covariates, we found, on one hand, that study participants who are divorced (compared to single) with schizophrenia diagnosis (compared to other psychotic or schizoaffective disorder) are more likely to have lower score on DAI-30. On the other hand, we found that study participants with a higher household income and longer duration of the psychotic illness were associated with greater DAI-30 score.Conclusion: The majority of participants preferred their current oral and LAI formulation. Drug attitude was influenced by several factors, including matched medication use. Focused psychoeducation should be considered for newly diagnosed, lower socio-economic groups and patients with non-affective psychosis to improve drug attitude.

Prescribing patterns of long-acting injectable antipsychotics in a community setting in South Africa

“…Various sociodemographic and clinical factors have been associated with the prescribing of LAI – APs. These factors include the duration of illness, 18 gender, 18 , 19 , 20 , 21 ethnicity, 22 , 23 education, 23 socio-economic status, 21 , 23 , 24 , 25 comorbid substance use disorders, 23 inpatient versus outpatient care, 20 acceptability to patients, 26 adherence to antipsychotic medication 3 , 7 and attitude of psychiatrists towards LAI – APs. 27 …”

“…Yet, it is reported internationally that the concurrent prescription of oral psychotropic medication is frequent, with 46% – 75% of patients on LAI – APs also receiving concurrent prescriptions of an oral psychotropic. 23 , 26 , 28 , 29 , 30 , 31 …”

“…Only a few local studies have included information on the prescription of LAI – APs, and these were either limited to patients of only one ethnic group, 33 patients recently discharged from a psychiatric hospital 34 or outpatients attending tertiary psychiatric hospital clinics. 26 …”

Attitudes and Willingness to Accept Long-Acting Injections for Patients With Schizophrenia in Beijing: A Cross-Sectional Investigation Based on Samples From the Communities

“…Although LAI has been clinically used in the United States and European countries for a long time, it is not long in China and unfamiliar to most Chinese patients. Roopun et al have pointed out that strengthening education can potentially improve treatment acceptance ( 34 ). Patients with a high level of education are more capable of accepting new things, so they have a higher willingness to accept LAI in this study.…”

“…A study conducted by Grover et al from India reported that 78.8% of patients are still willing to choose oral tablets, and only about 5% choose LAI as the first choice of treatment ( 33 ). Difficulty in going to the hospital on time for injections, pain and fear of needles, and thinking that it is unnecessary are the reasons why patients often talk about reluctance to accept LAI ( 33 , 34 ). As mentioned above, China's implementation of the hospital-community-combined model is not very effective.…”