Attitudes of European physicians towards the use of long-acting injectable antipsychotics

Maxine X Patel,Sylvie Di Nicola,Anna-Greta Nylander,Stephan Heres,Christophe Sapin,Nawal Bent-Ennakhil,Jean-Yves Loze

doi:10.1186/s12888-020-02530-2

Abstract

BackgroundPrescription 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.MethodsThe 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.ResultsOverall, 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).ConclusionsThe 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.

Highlights

Prescription rates for long-acting injectable (LAI) antipsychotic formulations remain relatively low in Europe despite improved adherence over alternative oral antipsychotic treatments
Sociodemographic and clinical experience data (Table 1) revealed that most physicians considered their country to have a history of large scale First-generation antipsychotic (FGA)-LAI use, i.e. accounting for > 20% of all antipsychotics prescriptions (80.9%), and the majority of these felt the number of FGA-LAI prescriptions had dropped (58.8%)
This study aimed to evaluate current attitudes and beliefs of European physicians towards the treatment of patients diagnosed with schizophrenia with LAI antipsychotics at a time when Second-generation antipsychotic (SGA)-LAIs are more commonly used in routine clinical practice

Summary

Introduction

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. Antipsychotic medications play a vital role in controlling symptoms of psychosis and minimizing the likelihood of relapse, [1] and yet patient non-adherence to oral firstand second-generation antipsychotics (FGAs and SGAs, respectively) is one of the main barriers to relapse prevention [2,3,4]. Observational studies may be more generalizable to clinical practice as they can include patients who are less likely to consent to or be eligible to participate in an RCT, but they do not control for confounding factors and remain vulnerable to an element of selection bias [22]

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