DOI

10.21007/con.dnp.2024.0079

Faculty Advisor

Sharon H. Little DNP, APRN, FNP-BC and Jacqueline Sharp DNP, APRN,PMHNP-BC

Document Type

Poster

Publication Date

Spring 4-16-2024

Disciplines

Health and Medical Administration | Health Services Administration | Health Services Research | Investigative Techniques | Medicine and Health Sciences | Mental and Social Health | Mental Disorders | Nursing | Nursing Administration | Other Psychiatry and Psychology | Psychiatric and Mental Health | Psychiatric and Mental Health Nursing | Psychiatry and Psychology | Public Health | Quality Improvement | Therapeutics

Abstract

Purpose/Background

Schizophrenia is a lifelong illness with recurrent and often debilitating symptoms that may impair daily functioning, cognition, behaviors, socialization, emotions, and expression. It is recognized as a global mental health burden that affects the individual, their family, and society. Medication nonadherence and resulting relapse detrimentally affect the patient’s physical and mental health and quality of life. They are associated with increased hospitalization and emergency room visits, substance use, suicide, and homelessness. Current guidelines endorse second-generation antipsychotics such as Risperidone and Aripiprazole as the first-line treatment for most cases of psychosis. However, long-acting injectable (LAIs) atypical antipsychotics are a promising alternative to overcome noncompliance in treating Schizophrenia and help increase treatment adherence, decrease the likelihood of discontinuation, and provide better symptom management. The purpose of this project is to assess the benefits long-acting injectable antipsychotics have on treatment adherence, decreased re-hospitalizations, and relapses for treating individuals with schizophrenia.

Methods

This retrospective chart review was performed at Vanderbilt Adult Psychiatry Outpatient Clinic (VPH-OP) via electronic database access by an EMR Analysts (EStar), where participants were selected based on inclusion criteria for the long-acting injectables group and the oral antipsychotic group. Inclusion criteria included current establishment as a patient at the VPH-OP Clinic, greater than 18 years of age, a diagnosis of schizophrenia spectrum disorders and bipolar disorders per the DSM-5, and current treatment with antipsychotic medication. Participants who met criteria based on medication were randomized into the long-acting injectable group (n-15) and oral antipsychotic group (n=15). Data was collected in the Redcap data collection tool for deidentification and included age, race, gender, diagnosis, oral or long-acting injectable medication, missed appointments, in-patient hospitalizations, and whether the medication was changed, maintained, or discontinued. Data was collected from October 1, 2022, to October 31, 2023. The study was approved by the respective Institutional Review Boards.

Results

The study showed that there is no significant difference in inpatient hospitalization between oral antipsychotics and long-acting antipsychotics. 3 out of 15 LAIs compared to 3 out of 15 oral antipsychotics participants had inpatient hospitalizations. The study showed a slight significant difference in medication changes, discontinuation, and missed medication appointments. In 3 out of 15 LAIs compared to 4 out of 15 oral antipsychotic participants, medication was changed or discontinued. 9 out of 15 LAIs compared to 10 out of 15 oral antipsychotics out of 15 LAIs compared to 10 out of 15 oral antipsychotics participants missed medication appointments.

Implications for Nursing Practice

The study shows there are some beneficial aspects to using LAIs compared to oral antipsychotics. Future studies with a larger sample size would be beneficial to evaluate treatment adherence and examine statistical differences between LAIs and oral antipsychotics in patients with schizophrenia. Adherence to treatment for schizophrenia has been a difficult task due to the complicated symptomology of side effects associated with antipsychotic medications. Continuous studies to find the most efficient medications are imperative to help advance the treatment of individuals with schizophrenia.

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