Improving care coordination for patients on longacting injectable antipsychotics transitioning from hospital to home: A work systems approach

Abstract

Objective: The goals of this study are to: (1) examine work system factors that influence care coordination for patients initiated and maintained on long-acting injectable antipsychotic (LAIA) medications and (2) characterize the role of health care providers including pharmacists in coordinating care for patients on LAIAs. Methods: The Systems Engineering Initiative for Patient Safety (SEIPS) work system and patient safety theoretical framework will guide this research. This study will be conducted within an inpatient psychiatric hospital and ambulatory psychiatric clinic that houses a pharmacy and medication injection clinic. Study participants will include: (1) patients >18 years of age who are prescribed LAIAs and (2) pharmacists and other health care providers in the inpatient and outpatient settings who are involved in the initiation and maintenance of LAIA therapy. The SEIPS model will be used to develop data collection instruments. Data collection will involve retrospective reviews of the electronic health record; direct observations at the inpatient hospital, ambulatory psychiatric clinic, and pharmacy; and audio-recorded interviews with study participants. Interview questions will focus study participant experiences with LAIA medication use across levels of care. Data will be thematic analyzed using the SEIPS model. Data will be analyzed to identify factors that positively and negatively impact care coordination for individuals on LAIAs as patients transition from hospital to home. Results: Research in progress. Implications: Individuals with chronic and persistent mental illness are often prescribed LAIA medications to improve medication adherence and patient outcomes. Care coordination between the inpatient and outpatient settings can be challenging. Gaps in care can lead to discontinuation of LAIA therapy which increases the risk for relapse and rehospitalization. By understanding the current process, we will identify barriers and system failures in care coordination to improve and standardize. Study findings will inform process improvement including proactive identification and resolution of factors that lead to LAIA therapy discontinuation and poor patient outcomes.