Interventions to Improve Standard Initiation of Long-Acting Injectable Antipsychotics in a University-Affiliated Psychiatric Hospital: A Quasiexperimental Study Publisher



Mousavi M ; Taghizadehghehi M ; Jafarzadehkohneloo A ; Mirsepassi Z ; Nejatisafa AA
Source: Journal of Clinical Pharmacy and Therapeutics Published:2025

Abstract

Introduction: Long-acting injectable antipsychotics (LAI-APs) were recommended to improve treatment adherence and reduce recurrence rates. Initiating LAI-APs can be challenging due to complexities in dosing schedules. Aim: We aimed to assess the impact of multifaceted interventions on the initial dosing schedule of LAI-APs in a university-affiliated psychiatric hospital. Methods: This study consisted of three phases: first, the preintervention baseline evaluation phase, followed by guideline development and active dissemination in the hospital (guideline presentation and educational session). Second, the 1 month peri-intervention phase, in which audit and feedback were performed. The postintervention phase consisted of a 3-month evaluation. All admitted patients for whom LAI-APs were initiated were identified and studied. The concordance with institutional guidelines was determined by considering the initial dose, initial interval, and oral overlap during three phases. Results: In total, 101, 31, and 51 orders were evaluated in the study phases, respectively. Guideline-concordant orders increased from 2.1% in baseline to 48.4% and 64.5% before and after feedback in the peri-intervention phase, respectively, and decreased to 21.6% in the postintervention phase (p < 0.001). Nonconcordance initial dose decreased from 83.7% at baseline to 38.7% in the second phase and reached 62% in the last phase (p < 0.001). The frequency of LAI-AP and OAP mismatch was 67.6%, 10.5%, and 21.9% in the three study phases, respectively (p < 0.001). The academic level of the attending physician increased the odds of an appropriate initial dose by 3.92 times. The odds of a proper initial interval were higher when the attending physician had a higher academic level (OR = 2.53, 95% CI = 1.25–5.12, p = 0.01) and was female (OR = 2.4, 95% CI = 1.09–5.29, p = 0.029). Conclusion: Concordance with the institutional guideline in LAI-APs dosing improved following multifaceted interventions; however, the improvement was not sustained. Therefore, continued audit and feedback might be necessary to maintain the effects. © 2025 Elsevier B.V., All rights reserved.