Discrepancy in Taiwanese psychiatrists’ preferences for long-acting injectable antipsychotics across facilities: a nationwide questionnaire survey

Neuropsychiatric Disease and Treatment, Feb 2018

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Discrepancy in Taiwanese psychiatrists’ preferences for long-acting injectable antipsychotics across facilities: a nationwide questionnaire survey

Neuropsychiatric Disease and Treatment Discrepancy in Taiwanese psychiatrists' preferences for long-acting injectable antipsychotics across facilities: a nationwide questionnaire survey Po-hsin Tsai 0 1 0 Department of Psychiatry, c hang gung Memorial hospital at Keelung , Keelung , Taiwan 1 college of Medicine, chang gung University , Taoyuan 2 Department of Psychiatry, c hang gung Memorial hospital at linkou , Taoyuan from rseo PowerdbyTCPDF(ww.tcpdf.org) ching-Yen chen 2,3 Background: Although many studies have discussed psychiatrists' attitudes toward long-acting injectable antipsychotics (LAIs), no previous study has focused on differences in preference based on the facilities in which the psychiatrists practiced. Materials and methods: A pilot survey was conducted in a medical center in northern Taiwan, and a questionnaire was then distributed at the annual conference of the Taiwanese Society of Psychiatry in 2013. The questionnaire included general demographic data and preferences for the use of LAIs in different situations. Results: A total of 142 psychiatrists were included in our study. Among them, 114 were male (80.3%), and most practiced in general hospitals (n=110, 77.5%). We found that general hospital psychiatrists were more likely to prescribe LAIs for patients in the acute stage and with positive symptoms than were psychiatric hospital psychiatrists. General hospital psychiatrists also tended to prescribe LAIs at every time point of the disease. Conclusion: General hospital psychiatrists were more likely to prescribe LAIs than those in psychiatric hospitals. Knowing the factors affecting psychiatrists' preferences may help us to develop a further study to explore “why” psychiatrists consider or do not consider LAIs in different facilities. Long-acting injectable antipsychotics (LAIs) are now seen by psychiatrists as advantageous in ensuring drug adherence. Many studies have demonstrated that LAIs can reduce the relapse rate and duration of hospitalization.1 For patients with poor compliance and inadequate treatment effect, LAIs can provide a choice other than oral antipsychotics to prevent relapses,2-4 lower hospitalization rates,3,5 and provide better disease control and quality of life, with less functional decline.6-8 Another advantage of LAIs is a stable plasma-drug level compared to the oral form of antipsychotics.9,10 On the other hand, the question of efficacy and tolerability of LAIs remains, as do concerns about the side effects of antipsychotics (eg, extrapyramidal symptoms, hyperprolactinemia, sedation, and metabolic side effects). In 2002-2003, the first second-generation LAI - risperidone microspheres - was introduced to the market, and it provided an alternative choice with fewer extrapyramidal symptoms. A study comparing first- and second-generation LAIs showed that there was no significant difference in discontinuation rates due to side effects.11 Currently, two second-generation LAIs, risperidone and paliperidone, are available in Taiwan, and they are widely used in patients with poor adherence or in the community. antipsychotic agents; general hospital; injections; psychiatric hospital - edad ropF open access to scientific and medical research O r i g i N a l r e s e a r c h Introduction edad ropF o l n w o d t n e m t a e r T d n a e s a e s i D c iitr a h c y s p o r u e N There are three major types of psychiatric facility in Taiwan: general hospitals, psychiatric hospitals, and private clinics. Generally speaking, psychiatrists in general hospitals focus more on physically related mental illness, psychiatric hospitals focus more on chronic psychosis, and private clinics focus on such neuroses as anxiety complaints and 810 sleep problems. A previous survey in the US revealed that l-J2u there were three major barriers to psychiatrists utilizing -12 LAIs: a lack of nursing support, the psychiatrist’s personal n5o preference, and insurance coverage.12 Due to nearly full .131 coverage by the Taiwanese National Health Insurance (NHI) .117 system,13 most medical costs are covered by NHI, including .34 LAIs. Unlike in psychiatric clinics, well-trained nursing yb5 staff in psychiatric hospitals and general hospitals can /om inject LAIs. Therefore, our study focused on psychiatrists’ .ssc personal preferences across different facilities. Our hypothreep esis was that facility was a factor influencing psychiatrists’ vo preferences for LAIs and their strategies in choosing LAIs ./dwww l.yone in clinical practice. / :s su ttp l h na from rseo Materials and methods A questionnaire was designed by the author based on clinical observations. A total of 35 psychiatrists in a medical center in northern Taiwan participated in a pilot analysis. The questionnaire was then distributed at the annual conference of the Taiwanese Society of Psychiatry in 2013. We used convenience sampling and asked the psychiatrists attending the conference to participate in the study. We included the p (...truncated)


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Chun-Hao Liu, Po-Hsin Tsai, Ching Yen Chen. Discrepancy in Taiwanese psychiatrists’ preferences for long-acting injectable antipsychotics across facilities: a nationwide questionnaire survey, Neuropsychiatric Disease and Treatment, 2018, pp. 429-433, DOI: 10.2147/NDT.S154490