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Community Behavioral Health Clinics Can Be Instrumental in Switching Patients to Long-Acting Injectable Antipsychotics
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Key Takeaways
- Long-acting injectables (LAIs) improve treatment adherence and outcomes in serious mental illnesses by providing consistent medication delivery and reducing relapse rates.
- Certified community behavioral health clinics (CCBHCs) offer integrated care, addressing complex needs and reducing hospitalizations for individuals with severe mental illness.
Research findings presented at the American Association of Psychiatric Pharmacy (AAPP) 2025 meeting provide a framework for how certified community behavioral health clinics (CCBHCs) can be crucial partners in switching patients with serious mental illness to long-acting injectable (LAI) antipsychotic therapies with a longer duration.1
Less frequent dosing can be more convenient | Image credit: N Lawrenson/peopleimages.com | stock.adobe.com
Long-Acting Injectable Therapies
LAIs represent a significant advancement in the treatment of serious mental illnesses like schizophrenia and bipolar disorder. These medications, which are typically administered via intramuscular or subcutaneous injection every 2 to 4 weeks or longer, offer a more consistent and reliable delivery of antipsychotic medication compared to daily oral formulations. This eliminates the reliance on daily patient adherence, which can be a substantial challenge for individuals grappling with the cognitive and motivational impairments often associated with these conditions. By ensuring a steady therapeutic level of medication, LAIs can lead to improved symptom control, reduced rates of relapse and hospitalization, and ultimately, a greater degree of stability and improved quality of life for patients.2,3
For some individuals, the less frequent dosing schedule can be more convenient and less stigmatizing than daily pill-taking, potentially fostering a greater sense of autonomy. Furthermore, clinicians can have greater confidence in medication delivery, allowing for more informed treatment decisions and a stronger therapeutic alliance with the patient. Although the initiation of LAIs often requires a period of oral antipsychotic stabilization and careful monitoring for tolerability, the long-term advantages of relapse prevention and functional outcomes make them a valuable tool in the comprehensive management of serious mental illness.4
Certified Community Behavioral Health Clinics
CCBHCs are designed to provide comprehensive, integrated care for individuals with mental health and substance use disorders, regardless of their ability to pay. These clinics offer a wide array of services, often under 1 roof, including crisis care, outpatient mental health and substance use treatment, primary care screening and monitoring, targeted case management, and psychiatric rehabilitation. By integrating these services and emphasizing coordination across different aspects of care, CCBHCs play a crucial role in addressing the complex needs of individuals with severe mental illness, promoting recovery, and reducing hospitalizations and involvement with the criminal justice system.5
Pharmacists are integral members of the multidisciplinary teams within CCBHCs or can partner with them in various ways. Psychiatric pharmacists, in particular, bring specialized expertise in psychotropic medications, playing a vital role in medication management, ensuring appropriate prescribing, monitoring for adverse effects and drug interactions, and providing patient education to enhance adherence and understanding of their treatment. They can collaborate with prescribers on complex issues, offer consultations on medication-related issues, and even participate in collaborative drug therapy management under established protocols.
Community pharmacists can also partner with CCBHCs by ensuring seamless medication access, providing adherence support programs, and serving as a point of contact for patients between clinic visits, contributing to the overall continuity of care. This collaborative approach optimizes medication outcomes and supports the holistic well-being of individuals with severe mental illness.6
Transitioning Patients to Longer Duration LAIs at CCBHCs
The research presented at AAPP focused on risperidone intramuscular LAI (Uzedy; Teva) and paliperidone palmitate (Invega Sustenna; Johnson & Johnson), which are 2 LAI options on the formulary for the CBHCC in the study. Paliperidone is the active metabolite of risperidone, meaning both medications have similar efficacy and adverse effect profiles. However, risperidone intramuscular LAI is administered every 2 weeks, whereas paliperidone palmitate is administered once per month.1
Switching from risperidone intramuscular LAI to paliperidone palmitate could improve patient adherence and lower the cost burden on the system by having less frequent injections. However, no formal process for implementing this switch was established at the CCBHC. As part of the study, the CCBHC developed a plan for transitioning patients from risperidone intramuscular LAI to paliperidone palmitate utilizing clinical pharmacy specialist review and coordination.1
Using Epic, 56 patients were identified who had been prescribed risperidone intramuscular LAI in the previous 12 months. A clinical pharmacist completed a thorough chart review to ensure the switch to paliperidone palmitate would be appropriate. Patients were organized by medication payor source, and emails were sent to the assigned psychiatric providers reviewing the potential benefits of switching to paliperidone palmitate, as well as the recommended conversion for each individual patient. The clinical pharmacy team was available to assist with any questions about the conversion and to help contact patients and caregivers as needed for education.1
Of the 56 patients identified, 30 were no longer receiving risperidone intramuscular LAI. Of those 30, 12 were switched to paliperidone palmitate, and the other 18 left services or switched to another therapy. Of the remaining 26 still receiving risperidone intramuscular LAI, 11 had documented reasoning for continuation.1
Although the majority of the 56 patients were not switched from risperidone intramuscular LAI to paliperidone palmitate, the authors said their project provided a framework for other CCBHCs to switch patients to LAIs with a longer duration.1
