Patient Satisfaction with Pharmacist-Administered Long-Acting Injectable Antipsychotics

Swetha Pradeep, Pharm.D, Community-University Health Care Center (CUHCC)

Background: According to the National Alliance of State Pharmacy Associations (NASPA) and the College of Psychiatric and Neurologic Pharmacists (CPNP), non-adherence to antipsychotic agents can be linked to higher risk of relapse, higher rates of hospitalization, and higher health care costs. Long-acting injectable antipsychotics (LAIAs) are one tool to help improve medication adherence in patients with psychotic disorders. Community pharmacists are in a unique position to assist in the administration of LAIAs given their accessibility, education, and training, and can contribute to expanding access to mental health services in all communities.

Objective: The primary objective of the study “Evaluating patient satisfaction with pharmacist-administered long-acting injectable antipsychotics in the community pharmacy”  assessed patient satisfaction with community pharmacist-administered LAIAs. Secondary objectives evaluated satisfaction with the current service compared to a similar service received elsewhere, and determined the relationship between patient demographics and likelihood of recommending the service to others.

Study Design: This prospective study occurred from December 2016 to February 2017 in Albertsons community pharmacies in Arizona, California, Hawaii, Idaho, Oregon, Texas, Virginia, and Washington. The survey, administered after the injection was received, included four sections: satisfaction in eleven areas (5 point Likert scale); open-ended items about positive aspects of the service and what could be improved; comparison of current service to a similar service provided elsewhere; and demographic information.

Patients included were adults 18 years and older receiving Abilify Maintena®, Invega Sustenna®, Invega Trinza®, or Risperdal Consta®. Patients who declined to complete survey were excluded.

Results: The 104 surveys collected (of 716 sent out) showed the majority of patients resided in CA or TX, were males younger than 40 years old, and had their current diagnosis for one to five years.

Of the 11 survey statements pertaining to the primary objective of patient satisfaction, nine received at least 95% positive responses (agreed or strongly agreed).  Among the nine were: comfort with service, trust in pharmacist, unrushed appointment, and likelihood of recommending service. Only 64% of patients responded positively regarding the location of the service, which may indicate the patient’s usual pharmacy is farther away from the pharmacy at which they receive their injection. Open-ended questions reflected similar responses as the likert-scale survey questions did. No feedback was provided regarding ways to improve the service.

In the secondary objective of comparing satisfaction with the current service to a similar service received elsewhere (n = 57), responses acknowledged clear communication and trust in the pharmacist. Seventy-seven percent of responders believed the pharmacist was as knowledgeable, or more knowledgeable, than other healthcare professionals offering this service. Eighty-two percent of responders reported this service was more convenient than a similar service received elsewhere. No relationship was found between patient demographics and recommending the service, likely due to small sample size of the study.

Conclusions: Overall patients were highly satisfied with receiving LAIAs at a community pharmacy due to the convenience of the service coupled with the pharmacist’s empathy and knowledge. Offering this service in the community pharmacy may greatly increase access to mental health services, particularly in rural areas. More research is needed to determine the clinical effects of pharmacist-administered LAIAs on adherence. Finally, the authors encourage pharmacists to refer to their local legislature regarding pharmacist administration of medications. In the Midwest, administration of LAIA is not currently allowed in MN or SD, but is allowed in ND and IA, and in WI with a collaborative practice agreement, according to NASPA.  Nationwide, 28 states allow for LAIA administration, eight allow administration with a collaborative practice agreement, 14 states do not allow administration, and it is unclear in one state.

Key Point: In the ongoing conversation about increasing access to care, community pharmacist-administered long-acting injectable antipsychotics should be considered an area for practice expansion.

References:

  1. Mooney EV, Hamper JG, Willis RT, Farinha TL, Ricchetti CA. Evaluating patient satisfaction with pharmacist-administered long-acting injectable antipsychotics in the community pharmacy. Am Pharm Assoc. 2018 Jul - Aug;58(4S):S24-S29.

  2. National Alliance of State Pharmacy Associations. Administration of Long-Acting Anti-psychotic Injectable Medications: State Specific Information. National Community Pharmacists Association.https://www.ncpanet.org/innovation-center/diversified-revenue-opportunities/administration-of-long-acting-injectable. Updated November 2016. Accessed August 11, 2018.

National Alliance of State Pharmacy Associations and College of Psychiatric and Neurologic Pharmacists. Resources: State Policy Recommendations for Pharmacist Administration of Medications. National Alliance of State Pharmacy Associations. https://naspa.us/resource/med-admin/ Published March 2017. Accessed August 5, 2018.