Interventions to Improve Standard Initiation of Long‐Acting Injectable Antipsychotics in a University‐Affiliated Psychiatric Hospital: A Quasiexperimental Study

Introduction Long‐acting injectable antipsychotics (LAI‐APs) were recommended to improve treatment adherence and reduce recurrence rates. Initiating LAI‐APs can be challenging due to complexities in dosing schedules. Aim We aimed to assess the impact of multifaceted interventions on the initial dosing schedule of LAI‐APs in a university‐affiliated psychiatric hospital. Methods This study consisted of three phases: first, the preintervention baseline evaluation phase, followed by guideline development and active dissemination in the hospital (guideline presentation and educational session). Second, the 1 month peri‐intervention phase, in which audit and feedback were performed. The postintervention phase consisted of a 3‐month evaluation. All admitted patients for whom LAI‐APs were initiated were identified and studied. The concordance with institutional guidelines was determined by considering the initial dose, initial interval, and oral overlap during three phases. Results In total, 101, 31, and 51 orders were evaluated in the study phases, respectively. Guideline‐concordant orders increased from 2.1% in baseline to 48.4% and 64.5% before and after feedback in the peri‐intervention phase, respectively, and decreased to 21.6% in the postintervention phase ( p < 0.001). Nonconcordance initial dose decreased from 83.7% at baseline to 38.7% in the second phase and reached 62% in the last phase ( p < 0.001). The frequency of LAI‐AP and OAP mismatch was 67.6%, 10.5%, and 21.9% in the three study phases, respectively ( p < 0.001). The academic level of the attending physician increased the odds of an appropriate initial dose by 3.92 times. The odds of a proper initial interval were higher when the attending physician had a higher academic level (OR = 2.53, 95% CI = 1.25–5.12, p = 0.01) and was female (OR = 2.4, 95% CI = 1.09–5.29, p = 0.029). Conclusion Concordance with the institutional guideline in LAI‐APs dosing improved following multifaceted interventions; however, the improvement was not sustained. Therefore, continued audit and feedback might be necessary to maintain the effects.