Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Lundbeck SAS, Issy-les-Moulineaux, France.
BMC Psychiatry. 2020 Mar 14;20(1):123. doi: 10.1186/s12888-020-02530-2.
Prescription rates for long-acting injectable (LAI) antipsychotic formulations remain relatively low in Europe despite improved adherence over alternative oral antipsychotic treatments. This apparent under-prescription of LAI antipsychotics may have multiple contributing factors, including negative mental health practitioner attitudes towards the use of LAIs.
The Antipsychotic Long acTing injection in schizOphrenia (ALTO) non-interventional study (NIS), conducted across several European countries, utilised a questionnaire that was specifically designed to address physicians' attitudes and beliefs towards the treatment of schizophrenia with LAI antipsychotics. Exploratory principal component analysis (PCA) of feedback from the questionnaire aimed to identify and characterize the factors that best explained the physicians' attitudes towards prescription of LAIs.
Overall, 136/234 solicited physicians returned fully completed questionnaires. Physicians' mean age was 48.5 years, with mean psychiatric experience of 20.0 years; 69.9% were male, 84.6% held a consultant position, and 91.9% had a clinical specialty in general adult care. Most physicians considered themselves to have a high level of clinical experience with LAI antipsychotics (77.2%), with an increased rate of LAI antipsychotics prescription over the last 5 years (59.6%). Although the majority of physicians (69.9%) declared feeling no difference in stress levels when offering LAI compared to oral antipsychotics, feelings of 'no/more stress' versus 'less stress' was found to influence prescription patterns. PCA identified six factors which collectively explained 66.1% of the variance in physician feedback. Multivariate analysis identified a positive correlation between physicians willing to accept usage of LAI antipsychotics and the positive attitude of colleagues (co-efficient 3.67; p = 0.016).
The physician questionnaire in the ALTO study is the first to evaluate the attitudes around LAI antipsychotics across several European countries, on a larger scale. Findings from this study offer an important insight into how physician attitudes can influence the acceptance and usage of LAI antipsychotics to treat patients with schizophrenia.
尽管长效注射型（LAI）抗精神病药物在改善依从性方面优于其他口服抗精神病药物，但在欧洲，此类药物的处方率仍然相对较低。这种 LAI 抗精神病药物的明显处方不足可能有多个促成因素，包括心理健康从业者对使用 LAI 的负面态度。
在几个欧洲国家进行的抗精神病长效注射治疗精神分裂症（ALTO）非干预性研究（NIS）使用了专门设计的问卷，以解决医生对 LAI 抗精神病药物治疗精神分裂症的态度和信念。对问卷反馈进行探索性主成分分析（PCA），旨在确定并描述最能解释医生处方 LAI 态度的因素。
共有 234 名受邀医生中的 136 人返回了完整填写的问卷。医生的平均年龄为 48.5 岁，平均精神科经验为 20.0 年；69.9%为男性，84.6%为顾问职位，91.9%有普通成人护理的临床专业。大多数医生认为自己在 LAI 抗精神病药物方面有较高的临床经验（77.2%），过去 5 年 LAI 抗精神病药物的处方率增加（59.6%）。尽管大多数医生（69.9%）表示在提供 LAI 与口服抗精神病药物相比时，他们的压力水平没有差异，但发现“无/更少压力”与“更少压力”的感觉会影响处方模式。PCA 确定了六个因素，这些因素共同解释了医生反馈中 66.1%的方差。多变量分析表明，医生愿意接受 LAI 抗精神病药物的使用与同事的积极态度之间存在正相关（系数为 3.67；p=0.016）。
ALTO 研究中的医生问卷是第一个在多个欧洲国家评估围绕 LAI 抗精神病药物的态度的研究，规模更大。该研究的结果提供了一个重要的视角，了解医生的态度如何影响 LAI 抗精神病药物的接受和使用，以治疗精神分裂症患者。
