Early use of long-acting injectables together with targeted staff training may facilitate short- and long-term functional recovery in patients with early-phase schizophrenia. Charlotte Emborg Mafi (OPUS Clinic, Aarhus University Hospital, Denmark) shared clinical insights and highlighted the importance of staff education for overcoming treatment barriers.
We need to pay more attention to functional recovery, said Dr Emborg during her presentation at EPA Virtual 2021. Maximizing health-related quality of life and attaining personal treatment goals are important treatment objectives for patients with schizophrenia,1-2 and for this we need to tailor treatment to the individual.
Focus on functional recovery
Non-adherence to medication is a significant issue in schizophrenia, and for patients who do not adhere to their treatment, the risk of relapse is almost five times higher five years after initial recovery compared to those who do adhere.3,4
New evidence confirms early LAIs reduce hospitalization
In a recently published study, use of a long-acting injectable (LAI) was shown to dramatically delay the time to first hospitalization and reduce the incidence rate of first hospitalization in patients with early-phase schizophrenia and first-episode psychosis.5
In the trial, conducted in a real-world clinical setting, study sites were randomized to encourage the use of an LAI (19 sites) or to continue with clinician’s choice of usual care (20 sites), which may or may not have included LAIs.5
At sites randomized to encourage use of the LAI, the incidence rate of first hospitalization was reduced by 44%, with a 15% absolute reduction in risk of hospitalization at 2-year follow-up, compared with those using usual care.5
LAIs are a natural part of the treatment package
We know that relapse can jeopardise patient functioning.6 Maintenance treatment with LAIs should not be reserved for patients later in the disease process, said Dr Emborg. For patients in whom maintenance treatment is indicated, second-generation LAIs should be proposed early to improve outcomes, including in younger patients - and this will translate into less relapse and fewer hospital stays.
Maintenance treatment with LAIs should not be reserved for patients later in the disease process
Optimal treatment can only be achieved with well-trained staff
In the aforementioned study, clinicians at sites that encouraged LAI use underwent a specific training program that included education on the role of non-adherence in relapse and hospitalization, the principles of shared decision-making, communication strategies, role-playing and ways to overcome logistical barriers to the use of LAI across different healthcare settings.5
Only 14% of patients at these sites did not accept the study because they did not want to use an LAI, highlighted Dr Emborg.5 So, training of the team is key to providing the best possible treatment to patients.
Team training is key to offering the best possible treatment
Dr Emborg pointed out "that barriers to use of LAIs often do not come from patients or caregivers, but from the clinicians themselves". "Actively involving patients in treatment decisions is key to successful outcomes", she said, "and training should be given to every staff member with patient contact, not only the psychiatrist and nurse".
Barriers to use of LAIs often do not come from patients or caregivers, but from the clinicians themselves
Tailored treatment can only be offered by a well-trained staff.
BE-NOTPR-0029; approval date 08/2021
Educational financial support for the symposium was provided by Otsuka Pharmaceutical Europe Ltd and H. Lundbeck A/S
