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For the most part, the COVID-19 pandemic did not affect the number of prescriptions for long-acting injectable antipsychotics (LAIs) for schizophrenia, providers reported in a survey.

Of the prescribers who responded to the survey, 59.8% said that they did not see any increases or decreases in their 2020 prescribing trends. Among this majority, most concerns about LAI prescribing included the possibility of exposing patients to COVID-19 (56.6%), patient concerns about transportation (45.5%), and staff concerns about COVID-19 exposure (42.2%), noted H. Lynn Starr, MD, of Janssen Scientific Affairs, at the 2021 Psych Congress, held virtually and in-person in San Antonio.

A total of 408 healthcare providers -- mostly physicians (77.7%) -- participated in the online survey; 17.6% reported seeing a decrease in the number of LAI prescriptions. The most commonly cited reasons for these decreases included patient and staff concerns about COVID-19 exposure (55.6% and 45.8%, respectively), facility closures or reduced visits (43.1%), and patient transportation issues (43.1%), the researchers reported in their poster.

For the 13.7% of providers who said that their LAI prescriptions increased, common contributing factors included patient concerns with transportation (44.6%) and, notably, an increased confidence in adherence with LAIs (44.6%).

LAIs have been shown to improve adherence and symptom control and reduce the rate of hospitalizations in patients with schizophrenia, which has an annual prevalence range of 0.25% to 0.64% in the U.S.

"Given the role of LAIs in reducing hospitalizations compared to oral antipsychotics, as well as the challenges associated with provision of in-person care during the COVID-19 pandemic, it was important to evaluate changes in the late 2020 LAI prescribing and to explore healthcare providers' expectations for prescribing in 2021," Starr and colleagues wrote.

When asked how, if at all, these dynamics were expected to change in 2021, 44.1% of providers said that they expected that their LAI prescriptions would remain unchanged; common contributing factors among this group included the cost of treatment for patients (45%), the clinical staff availability to administer LAIs onsite (38.9%), and the number of schizophrenia patients (37.8%).

About 43% of providers said they expected LAI prescriptions to increase in 2021, naming the number of schizophrenia patients at their clinical practice (36%), cost of treatment (36%), and onsite staff (33.7%) as common factors that might contribute to this trend.

Only 3.4% of LAI prescribers said that they expected to see a decrease in prescriptions in 2021, with clinical staff availability remaining their most common primary concern (57.1%).

These data were collected from Nov. 17 to Dec. 12, 2020 through an anonymous, cross-sectional, double-blind online survey. All participants were recruited from a nationwide panel; in order to meet eligibility requirements, participants had to specialize in psychiatry, had to have prescribed LAIs as a treatment for schizophrenia in the past 12 months, and had to have at least one patient with schizophrenia treated with LAIs in their monthly caseload.

Aside from physicians, other respondents included nurse practitioners (17.2%) and physician assistants (5.1%). Of all frequent LAI prescribers, 59.1% reported having more than 10 years of practice in psychiatry, and the most commonly reported practice sites were community health centers (27.9%), private practices (22.8%), and inpatient psychiatric units (15.2%). The vast majority -- 92.7% -- were located in urban areas, with just 7.1% located in rural areas.

The authors acknowledged that the self-report nature of the survey was a major limitation to the research, given recall bias. They also noted that selection bias remained a limitation, despite their efforts to minimize it by enrolling participants through a nationwide panel.

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