Determining what practising clinicians believe about long-acting injectable antipsychotic medication

Abstract

Objective. To explore the factors that influence clinician prescribing choice when using depot anti-psychotics. Methods. A two-phase qualitative exploration of the attitudes to and knowledge about risperidone long-acting injection (RLAI) in a group of New Zealand psychiatrists. The first phase was conducted shortly after the treatment was funded (n = 16), the second phase was a year or so later (n = 35). Data was gathered using a focus group technique with scenario stimulus. The data were examined using thematic analysis. Results. Themes fitted the broad categories of who RLAI was used for, how it was best used, what were the efficacy determinants and what adverse effect monitoring occurred. For many areas of exploration there was a gap between actual practice and what the psychiatrist thought might be best practice. There was considerable variance in details regarding the administration of the treatment including dose, titration and efficacy monitoring. Conclusions. The results confirm the utility of quantitative exploration in understanding prescribing choice. The effect of outdated views regarding long-acting injectable (LAI) antipsychotics contributes to a gap between actual practice and what is thought to be desirable. The study targeted RLAI but findings are likely to also pertain to other LAI anti-psychotics.

Key words::

• Depot antipsychotic
• psychiatrist attitudes
• prescriber choice
• factors determining prescribing behaviour

Acknowledgements

The authors are very grateful to the psychiatrists who gave their time to this research and who allowed use of their personal comments and stories.

Statement of interest

This work was supported by Janssen-Cilag New Zealand Ltd. This support included reimbursement of expenses with regard to travel, meeting space and catering. It also supported KD in attendance at meetings and data analysis. Janssen-Cilag did not influence the choice of participants and did not have access to the data gathered. The preparation of this manuscript has been conducted independently.

The nature of the support provided by Janssen-Cilag and the independence of the data analysis and reporting was made clear to participants. At commencement of each meeting participants were reminded that this was a qualitative research inquiry and that they agreed to audio-recording and transcribing at both phases of the study.

Dr. Miles and Dr. Wheeler have conducted research trials sponsored by Janssen-Cilag (New Zealand and globally), and have received honoraria for preparing presentations. Ms Davies has had contracts of service with Janssen-Cilag New Zealand Ltd.