Anthony Lucido, Pharm.D. BCPS, Danielle Moses, Pharm.D.
Long-acting injectable (LAI) medications are a mainstay of treatment for patients suffering from chronic illnesses such as schizophrenia and bipolar disorder.1 However, lack of access to LAIs is a well-known barrier to LAI use in the psychiatric patient population despite the knowledge that early treatment can alter disease course and that LAIs have been advocated as standard of care.2,3 Patients receiving LAIs at hospital discharge did not have a consistent care pathway after discharge resulting in disruptions in therapy. A LAI Clinic was created to improve the care of psychiatric patients receiving LAIs. The goals were to improve patient access to providers, remove patient financial barriers through insurance optimization and charity, and improve the financial performance of the hospital by reducing costs and increasing revenue.
Implementation was accomplished through LEAN events led by a multidisciplinary team with a psychiatric clinical pharmacy specialist (CPS) as champion. The LAI Clinic employs several innovative strategies to accomplish its goals including LAI antipsychotic per pharmacy dosing protocol for transitions of care, complimentary transport to and from the clinic, group or individual therapy, a fresh meal during the visit, access to a clinic-based pharmacy benefit specialist who ensures coverage of medications or facilitates enrollment in patient assistance programs, access to a psychiatrist, and a collaborative practice agreement between the psychiatrist and CPS to prescribe medications.
The LAI Clinic started with 4 patients in January 2018 and by July 2018 had a total of 126 patients with a retention rate of 91%. The collaborative practice agreement allowed for additional capacity and rapid growth. The success of the clinic is demonstrated by improved access to critical medications for an underserved population and by financial benefits through increased outpatient pharmacy revenue. This program may lead to a reduction in readmission rates for patients using LAIs. Follow-up research to confirm this hypothesis is ongoing. Additionally, the clinic has afforded ineffable improvement to the quality of life of many patients. The clinic has witnessed the restoration of patient relationships and attainment of housing and employment. Gratitude for and satisfaction with the clinic has been forwarded to hospital administration by patients, family members, and individuals in the local community. Local and national news has covered the clinic.
The successful implementation of the LAI Clinic represents great potential for pharmacists across the country. It has validated the ability of pharmacists to positively impact and provide exemplary care to patients by utilizing the full potential of pharmacists’ unique education and licensure.
References
- Kim B, Lee SH, Yang YK et al. Long-Acting injectable antipsychotics for first-episode schizophrenia: the pros and cons. Schizophr Res Treatment. 2012; 2012:560836. doi: 10.1155/2012/560836. Epub 2012 Aug 14.
- Parellada E, BIoque M. Barriers to the use of long-acting injectable antipsychotics in the management of schizophrenia. CNS Drugs. 2016; 30:689-701.
- Zipursky RB, Menezes NM, Streiner DL. Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review. Schizophr Res. 2014; 152:408-14. doi: 10.1016/j.schres.2013.08.001. Epub 2013 Aug 21.
