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BRIEF RESEARCH REPORT article

Front. Health Serv.
Sec. Implementation Science
Volume 4 - 2024 | doi: 10.3389/frhs.2024.1385398

Multi-level barriers and facilitators to implementing evidence-based antipsychotics in the treatment of early-phase schizophrenia

Provisionally accepted
Allison Carroll Allison Carroll 1*Delbert G. Robinson Delbert G. Robinson 2John M. Kane John M. Kane 2Avram Kordon Avram Kordon 1Jennifer Bannon Jennifer Bannon 1Theresa Walunas Theresa Walunas 1C H. Brown C H. Brown 1
  • 1 Feinberg School of Medicine, Northwestern University, Chicago, United States
  • 2 Northwell Health, New York, New York, United States

The final, formatted version of the article will be published soon.

    Introduction: Long-acting injectable (LAI) antipsychotic medications and clozapine are effective yet underutilized medical therapies in early intervention services. The purpose of this study was to conduct a pre-implementation evaluation of contextual determinants of early intervention programs to implement innovations optimizing LAI antipsychotic and clozapine use within a shared decision-making model. Methods: Semi-structured interviews explored barriers and facilitators to implementing LAI antipsychotics and clozapine in early intervention services. Participants were: prescribers (n=2), non-prescribing clinicians (n=5), administrators (n=3), clients (n=3), and caregivers (n=3). Interviews were structured and analyzed using the Consolidated Framework for Implementation Research (CFIR 2.0). Results: Participants were supportive of using LAI antipsychotics, despite barriers (e.g., transportation, insurance coverage), while most were unfamiliar with clozapine (Innovation). Critical incidents (e.g., COVID-19) did not interfere with implementation, while barriers included lack of performance measures; stigma affecting willingness to take medication; and clozapine was a “last resort” (Outer Setting). Treatment culture was described as client-centered and collaborative, and most participants indicated LAI antipsychotic use was compatible with clinic workflows, but some were in need of resources (e.g., individuals trained to administer LAI antipsychotics; Inner Setting). Participants on the healthcare team expressed confidence in their roles. Family education and collaborative decision-making were recommended to improve client/family engagement (Individuals). Participants related the importance of tracking medication compliance, addressing client concerns, and providing prescribers with updated guidelines on evidence-based treatment (Process). Discussion: Results may guide implementation strategy selection for future programs seeking to optimize the use of LAI antipsychotics and clozapine for early-phase schizophrenia, when appropriate.

    Keywords: Consolidated Framework for Implementation Research, Patient perspective, Schizophrenia, Coordinated specialty care, stakeholder engagement, Implementation determinants, antipsychotic medication

    Received: 12 Feb 2024; Accepted: 23 Sep 2024.

    Copyright: © 2024 Carroll, Robinson, Kane, Kordon, Bannon, Walunas and Brown. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Allison Carroll, Feinberg School of Medicine, Northwestern University, Chicago, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.