This retrospective drug-use evaluation was conducted at 8 of the acute care hospitals of the Fraser Health Authority in British Columbia. In total, these 8 hospitals have about 2500 acute care beds. The study protocol was approved by the Fraser Health Research Ethics Board.

The primary outcome was the proportion of patients with a prescription for long-acting risperidone for injection for whom the drug was prescribed appropriately, according to the following 4 criteria: patient had an approved indication for therapy, dosing interval was appropriate, dose-escalation schedule was appropriate, and patient received antipsychotic supplementation (Table 1). The first criterion (approved indication for therapy) was based on the manufacturer’s product monograph for long-acting risperidone for injection7 and the special authority requirements of British Columbia’s drug coverage program, PharmaCare. The PharmaCare special authority program assesses patients’ situations on a case-by-case basis, and grants full benefit status for medications dispensed in the community if they are prescribed for specific clinical indications. The provincial requirements were included because it would be problematic to discharge a patient with limited  financial resources with a prescription for a relatively expensive medication, such as long-acting risperidone for injection, without ensuring that he or she would have adequate financial support in the community. The remaining 3 criteria for appro­priate prescribing were based on dosing recommendations in the product monograph. Achievement of all 4 criteria was required for designation of prescribing as appropriate.

The following secondary outcomes were also determined: proportion of patients with documented predischarge approval from PharmaCare for special authority drug coverage for risperidone, length of the hospital stay, number of doses of risperidone received during the admission, initial dose of risperidone received in hospital, and number of antipsychotic medications prescribed before admission and at the time of discharge from hospital. The investigators also wanted to determine if there was an overall reduction in the use of oral antipsychotics, as long-acting risperidone for injection is expected to reduce the number of medications taken orally, following appropriate dosage titration.
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Table 1. Criteria for Appropriate Prescribing of Long-Acting Risperidone for Injection

Criterion


Indicationt Dosing interval* Dose
escalation schedule* Antipsychotic supplementation*

Details


Schizophrenia or related psychotic
disorder
12-16 daysafter previous injection

Notmore frequently than every 25-28 days

Oral
antipsychotic supplementation for at least
18-21 days after first injection OR

Conventional long-acting antipsychotic by injection within 5 days
before receiving first injection of risperidone

Patients for whom long-acting risperidone for injection was prescribed between July 1, 2007, and July 22, 2008, as recorded in the computer system of each acute care hospital, were eligible for the study. Each patient’s chart and electronic record were screened to determine if he or she met the study’s eligibility criteria. Patients were included if they had been newly started on long-acting risperidone for injection during the index hospital admission. Patients were excluded if they had received this drug formulation at any time within the 6 weeks before the index admission. Patients were also excluded if there were insufficient data in their health records to allow full assessment of the criteria for appropriateness of prescribing. For example, if a patient was discharged soon after receiving his or her first dose and there were no medication-related discharge notes, it was not possible to determine if the dosing interval had been every 2 weeks, if dosage increases had been ordered no sooner than every 4 weeks, or if there was sufficient overlap with oral antipsychotic supplementation for at least 3 weeks. suhagra

A standardized data collection form was used to record relevant patient information. Descriptive statistics, including means and standard deviations for proportional prevalence data, are reported here. After the results were compiled and analyzed, the study investigators planned to meet with stakeholders from physician, pharmacy, and nursing groups to discuss how prescribing of this agent might be improved and to promote appropriateness of use, if needed.