Outcomes comparison of long-acting injectable antipsychotic initiation in treatment-naïve veterans in the inpatient versus outpatient setting

Long-acting injectable (LAI) antipsychotics have become an integral component in the treatment of schizophrenia and other psychotic disorders. Long-acting injectables may be initiated in either the inpatient or outpatient setting; however, there have been no studies to evaluate whether LAI treatment initiation setting impacts patient outcomes. This study sought to assess whether outcomes, specifically psychiatric hospitalization rates, time to hospitalization, and adherence with injections, differed between patients started on LAIs in the inpatient versus outpatient setting. Methods: The electronic medical records of all veterans prescribed an LAI at the McGuire Veterans Affairs Medical Center from September 2009 through September 2014 were reviewed in this retrospective study. Veterans met inclusion criteria if they were prescribed an LAI during the study period and were excluded if they had received an LAI prior to September 2009 or if the LAI was started at an outside facility. Patients were separated into treatment groups according to initiation location. The primary outcomes included psychiatric hospitalization rates and time to hospitalization. The secondary outcome measured the proportion of LAI injections received. Results: Fifty-five LAI treatment-naïve veterans were included in this study. No statistically significant differences were found in psychiatric hospitalization rates, time to hospitalization, or proportion of LAI injections received when comparing the inpatient and outpatient treatment initiation groups. Discussion: Psychiatric hospitalization rates, time to hospitalization, and adherence to LAIs did not differ between the inpatient and outpatient treatment groups, suggesting that treatment initiation location does not have an effect on patient outcomes.