Attitudes Driving Regional Differences in LAI Antipsychotic Utilization for Schizophrenia Among Healthcare Professionals, Patients, and Caregivers (ADVANCE): Results From a Multinational Survey Study

Long-acting injectable antipsychotics (LAIs) improve adherence and reduce schizophrenia relapse rates vs oral antipsychotics (OAs) but remain underused. The ADVANCE study explored country-level differences in LAI use among healthcare professionals (HCPs), patients, and caregivers, to identify drivers of LAI use. ADVANCE included participants from Australia, Canada, China, Germany, Israel, South Korea, Spain, and the United States. Eligible HCPs spent ≥25% of their time in direct patient care, managed an adult population of whom ≥10% have schizophrenia, and treated patients prescribed LAIs. Patients aged ≥18 years and caregivers of adults living with schizophrenia who had tried/been offered an LAI were included. Participants completed a 30-minute survey. Systemic factors reported by HCPs (N = 791) associated with higher LAI use included being a physician vs nonphysician, having Hispanic/Latino/Spanish ethnicity, managing more adult patients with schizophrenia, and having more staff and nurse support. Nonadherence to OAs was the main HCP-reported reason for LAI recommendation. Patient characteristics, lack of available LAIs corresponding to OAs, and perceptions of patients’ behavior were top reasons HCPs would not recommend an LAI. For patients (N = 470), symptom improvement and HCP recommendation and, for caregivers (N = 381), ease of injections, reduced hospitalizations, and fewer side effects were the main reasons for LAI acceptance. The top reason patients and caregivers declined LAIs was concern about side effects. Results from ADVANCE demonstrate that systemic and attitudinal factors influence LAI use by HCPs and these factors vary by country. Enhancing HCP-patient communication may improve LAI acceptance.