Paton Carol, Okocha Chike I, Patel Maxine X
Oxleas NHS Foundation Trust, Pinewood House, Pinewood Place, Dartford DA5 2DX, Kent, UK Centre for Psychiatry, Imperial College London, London, UK.
Oxleas NHS Foundation Trust, Dartford, UK.
Ther Adv Psychopharmacol. 2022 Feb 15;12:20451253211072347. doi: 10.1177/20451253211072347. eCollection 2022.
The use of continuing antipsychotic medication is an established evidence-based strategy for preventing relapse in people with schizophrenia, but medication adherence is known to be suboptimal. Covert non-adherence can be eliminated by the use of long-acting injectable (LAI) formulations. We sought to (1) raise awareness among clinicians of the potential benefits of LAI antipsychotic formulations, (2) increase use of these formulations for the treatment of schizophrenia in routine clinical practice and thereby (3) reduce the number of relapses requiring hospitalisation in patients with schizophrenia under our care.
Educational initiatives, promotion of reflective practice and patient-specific reminders were used to prompt increased use of LAI antipsychotic medication for patients with schizophrenia. Data relating to the use of these medications and the number of acute admissions for schizophrenia spectrum disorders (F20-29, ICD-10) over time were extracted from existing clinical information systems.
Over the 3-year time frame of our local initiative, the use of LAI antipsychotic preparations increased by 11%, the number of acute admissions for schizophrenia/schizoaffective disorder (F20 and F25) decreased by 26% and the number of acute bed days occupied by patients with these diagnoses decreased by 8%. The number of admissions for other psychosis diagnoses (F21-24 and F28-29) did not show the same pattern of improvement.
In our health care organisation, raising clinicians' awareness of the evidence base relating to the potentially favourable benefit-risk balance for LAI antipsychotic medication compared with oral formulations resulted in more use of the former. There were accompanying reductions in acute admissions and occupied bed days for patients with schizophrenia.
持续使用抗精神病药物是预防精神分裂症患者复发的一种既定的循证策略，但众所周知，药物依从性并不理想。使用长效注射（LAI）制剂可消除隐蔽性不依从情况。我们试图：（1）提高临床医生对LAI抗精神病制剂潜在益处的认识；（2）在常规临床实践中增加这些制剂用于治疗精神分裂症的使用量，从而（3）减少我们所护理的精神分裂症患者中需要住院治疗的复发次数。
采用教育举措、促进反思性实践以及针对患者的提醒，以促使增加对精神分裂症患者使用LAI抗精神病药物。随着时间推移，从现有的临床信息系统中提取与这些药物的使用以及精神分裂症谱系障碍（F20 - 29，国际疾病分类第十版）急性入院次数相关的数据。
在我们当地举措的3年时间范围内，LAI抗精神病制剂的使用量增加了11%，精神分裂症/分裂情感性障碍（F20和F25）的急性入院次数减少了26%，这些诊断患者占用的急性病床天数减少了8%。其他精神病诊断（F21 - 24和F28 - 29）的入院次数未呈现相同的改善模式。
在我们的医疗保健机构中，提高临床医生对与口服制剂相比LAI抗精神病药物潜在有利的效益风险平衡相关证据基础的认识，导致更多地使用前者。同时，精神分裂症患者的急性入院次数和占用病床天数有所减少。
