Advertisement

Community Mental Health Journal

, Volume 47, Issue 6, pp 654–659 | Cite as

Barriers to, and Strategies for, Starting a Long Acting Injection Clinic in a Community Mental Health Center

  • Dawn I. VelliganEmail author
  • Elisa Medellin
  • Meredith Draper
  • Natalie Maples
  • Albana Dassori
  • Troy A. Moore
  • Linda Lopez
Original Paper

Abstract

As many as 50% of patients with schizophrenia do not take oral antipsychotic medications as prescribed, yet long acting injections are rarely utilized. Community agencies that serve this population are often over-burdened and poorly funded. There are negative attitudes on the part of both physicians and consumers about injections. Transportation and logistics are often problematic. We describe the unique opportunity provided by the need for bi-weekly or monthly injections to establish a recovery-oriented group around injection visits. Our approach discusses methods and resources to help overcome some of the common barriers by establishing advocates within the agency, establishing necessary infrastructure, providing education for consumers, providers, and staff, sharing information about successful outcomes with clinic staff and working through billing issues. We also recommend public advocacy on the part of the clinic and consumers to work with state funding sources to change regulations that may limit appropriate clinical care.

Keywords

Long-acting injection Outcomes Medication adherence Barriers to use 

Notes

Acknowledgments

Supported by funding from Ortho-McNeil Janssen Scientific Affairs, LLC.

References

  1. Adams, C. E., Fenton, M. K., Quraishi, S., & David, A. S. (2001). Systematic meta-review of depot antipsychotic drugs for people with schizophrenia. British Journal of Psychiatry, 179(4), 290–299.PubMedCrossRefGoogle Scholar
  2. Babiker, I. E. (1987). Comparative efficacy of long-acting depot and oral neuroleptic medications in preventing schizophrenic recidivism. The Journal of Clinical Psychiatry, 48(3), 94–97.PubMedGoogle Scholar
  3. Buchannan, R., Kreyenbuhl, J., Kelly, D., Noel, J., Boggs, D., Fischer, B., et al. (2010). The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophrenia Bulletin, 36(1), 71–93.CrossRefGoogle Scholar
  4. Dall, T. M., Wagner, A., Zhang, Y., Yang, W., Arday, D. R., & Ganatt, C. J. (2010). Outcomes and lessons learned from evaluating TRICARE’s disease management programs. The American Journal of Managed Care, 16(6), 438–446.PubMedGoogle Scholar
  5. Davis, J. M., Janicak, P. G., Singla, A., & Sharma, R. P. (1993). Maintenance antipsychotic medication. In T. R. E. Barnes (Ed.), Antipsychotic drugs and their side effects (pp. 183–203). New York, NY: Academic Press.Google Scholar
  6. Dolder, C. R., Lacro, J. P., Dunn, L. B., & Jeste, D. V. (2002). Antipsychotic medication adherence: Is there a difference between typical and atypical agents? American Journal of Psychiatry, 159(1), 103–108.PubMedCrossRefGoogle Scholar
  7. Gilmer, T. P., Dolder, C. R., Lacro, J. P., Folsom, D. P., Lindamer, L., Garcia, P., et al. (2004). Adherence to treatment with antipsychotic medication and health care costs among medicaid beneficiaries with schizophrenia. American Journal of Psychiatry, 161, 692–699.PubMedCrossRefGoogle Scholar
  8. Glazer, W. M., & Kane, J. M. (1992). Depot neuroleptic therapy: An underutilized treatment option. The Journal of Clinical Psychiatry, 53(12), 426–433.PubMedGoogle Scholar
  9. Heres, S., Hamann, J., Kissling, W., & Leucht, S. (2006). Attitudes of psychiatrists toward antipsychotic depot medication. Journal of Clinical Psychiatry, 67(12), 1948.PubMedCrossRefGoogle Scholar
  10. Hirsch, S. R., & Barnes, T. R. E. (1995). The clinical treatment of schizophrenia with antipsychotic medications. In S. R. Hirsch & D. R. Weinberger (Eds.), Schizophrenia. Oxford: Blackwell.Google Scholar
  11. Kane, J. M., Aguglia, E., Altamura, A. C., Gutierrez, J. L. A., Brunello, N., Fleischhacker, W. W., et al. (1998). Guidelines for depot antipsychotic treatment in schizophrenia. European Neuropsychopharmacology, 8(1), 55–66.PubMedCrossRefGoogle Scholar
  12. Lambert, T., Brennan, A., Castle, D., Kelly, D. L., & Conley, R. R. (2003). Perception of depot antipsychotics by mental health professionals. Journal of Psychiatric Practice, 9(3), 252–260.PubMedCrossRefGoogle Scholar
  13. Llorca, P. M. (2008). Partial compliance in schizophrenia and the impact on patient outcomes. Psychiatry Research, 161(2), 235–247.PubMedCrossRefGoogle Scholar
  14. Moller, H. J. (2005). Antipsychotic agents. Gradually improving treatment from the traditional oral neuroleptics to the first atypical depot. European Psychiatry, 20(5–6), 379–385.PubMedCrossRefGoogle Scholar
  15. Olfson, M., Mechanic, D., Hansell, S., Boyer, C. A., Walkup, J., & Weiden, P. (2000). Predicting medication noncompliance after hospital discharge among patients with schizophrenia. Psychiatric Services, 51(2), 216–222.PubMedCrossRefGoogle Scholar
  16. Schooler, N. R. (2003). Relapse and rehospitalization: Comparing oral and depot antipsychotics. Journal of Clinical Psychiatry, 64(Suppl 16), 14–17.PubMedGoogle Scholar
  17. Velligan, D. I., Diamond, P. M., Lopez, J., Castillo, D. A., Maples, N. J., Lam, F., et al. (2007a). Cognitive adaptation training improves adherence to medication and functional outcome in schizophrenia. Schizophrenia Bulletin, 33(2), 608.Google Scholar
  18. Velligan, D. I., Lam, F. Y. W., Ereshefsky, L., & Miller, A. L. (2003). Psychopharmacology: Perspectives on medication adherence and atypical antipsychotic medications. Psychiatric Services, 54(5), 665–667.PubMedCrossRefGoogle Scholar
  19. Velligan, D. I., Wang, M., Diamond, P. M., Glahn, D. C., Castillo, D., Bendle, S., et al. (2007b). Relationships among subjective and objective measures of adherence to oral antipsychotic medications. Psychiatric Services, 58(9), 1187–1192.PubMedCrossRefGoogle Scholar
  20. Velligan, D. I., Weiden, P. J., Sajatovicm, M., Scott, J., Carpenter, D., Ross, R., et al. (2008). The expert consensus guidline series: Adherence problems in patients with serious and persistent mental illness. Journal of Clinical Psychiatry.Google Scholar
  21. Weiden, P. (1995). Postdischarge medication compliance of inpatients converted from an oral to a depot neuroleptic regimen. Psychiatric Services, 46(10), 1049–1054.PubMedGoogle Scholar
  22. World Health Organization (2006). Safety of injections: A brief background. Fact sheet no. 231. Retrieved from http://www.who.int/mediacentre/factsheets/fs231/en/, retrieved on January 3, 2011.

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Dawn I. Velligan
    • 1
    Email author
  • Elisa Medellin
    • 1
  • Meredith Draper
    • 1
  • Natalie Maples
    • 1
  • Albana Dassori
    • 1
  • Troy A. Moore
    • 1
  • Linda Lopez
    • 1
  1. 1.Department of Psychiatry, MS 7792University of Texas Health Science Center San AntonioSan AntonioUSA

Personalised recommendations