A total of 116 patients for whom long-acting risperidone for injection was prescribed at 1 of the 8 acute care sites over the study period were identified and screened (Figure 1). For 82 (71%) of these, risperidone therapy had been initiated during the index admission, and they were screened further for inclu­sion in the study. The remaining 34 (29%) patients were excluded either because they had not received at least 1 dose of the drug or because they were continuing therapy that had been initiated in the community. Of the 82 patients who were newly started on long-acting risperidone for injection, 27 were excluded because of early discharge from hospital, most within 2 weeks after receiving their first dose. For these 27 patients, there were insufficient data to assess the appropriateness of dos­ing interval, the dose escalation schedule, or the provision of antipsychotic supplementation. Therefore, 55 patients were included in the study (Table 2).

Table 2. Baseline Characteristics of 55 Patients Included in Evaluation of Appropriateness of Prescribing of Long-Acting Risperidone for Injection

Characteristic

No.(%) of Patients* (n = 55)

Demographic


Age, mean ± SD (yr) Sex (males)

40 ±14 29 (53)


Factors contributing to admission


Decompensation

Noncompliance with therapy

Trial of long-acting risperidone for
injection


54 (98) 44 (80) 2 (4)


Prescriber of long-acting risperidone for injection


Psychiatrist Other physician


55 (100)
0 (0)


Primary psychiatric (axis I) diagnosis

Schizophrenia

Schizoaffective disorder

Psychosis not otherwise specified

Bipolar disorder (with or without
psychotic features)


25 (45)

15 (27) 9 (16) 6 (11)


Residence before hospital admission

Independent living Family home

Boarding home or semi-independent
living Other hospital No fixed address Hotel or motel


31 (56)
12 (22)


7 (13)

2 (4) 2
(4) 1 (2)

The proportion of patients for whom the individual appropriateness criteria were fulfilled varied from 78% to 96% (Figure 2). For 33 (60%) of the 55 patients included in the evaluation, all 4 criteria were fulfilled and prescribing was deemed appropriate. Considering each criterion individually, 2 patients (4%) had an inappropriate indication for the drug (bipolar I disorder without psychotic features), 5 (9%) received the second dose of risperidone by injection too early or too late, and for 12 (22%) the dose was escalated too quickly (earlier than every 4 weeks). Of the 12 patients for whom dosing escalation was inappropriate, 9 received an initial dose of 25 mg and a second dose of 37.5 mg 2 weeks later. Seven (13%) of the patients did not receive adequate antipsychotic supplementa­tion to overlap with the initiation of long-acting risperidone for injection. Of these patients, one did not receive any supplemental therapy. For the remainder, oral antipsychotic supplementation was prescribed but for less than the recommended minimum duration of 3 weeks. For 4 (7%) of the 55 patients, prescribing was deemed inappropriate because of failure to fulfill multiple criteria. silagra tablets

Figure 1. Selection of patients

Figure 1. Selection of patients for inclusion in an evaluation of appropriateness of prescribing of long-acting risperidone for injection.

Only 28 (51%) of the patients had documented predis- charge approval under special authority from PharmaCare for long-acting risperidone therapy. Other secondary outcomes are reported in Table 3. Cialis Jelly

Figure 2. Proportion of 55 patients

Figure 2. Proportion of 55 patients newly started on long-acting risperidone for injection for whom individual appropriateness criteria were met.

Table 3. Secondary Outcomes

Outcome No. (%) of Patients

or
Mean ± SD (n
= 55)


Documented approval under special
authority of provincial drug coverage program


28 (51)


Length of hospital stay (days) Since
admission


39 ± 24


Since first dose of long-acting
risperidone by injection


30 ± 21


No. of doses of long-acting
risperidone by injection received in hospital

2.6 ± 1.2


Initial dose of long-acting
risperidone by injection for new starts


12.5 mg


3 (5)


25 mg


49 (89)


37.5 mg


3 (5)


50
mg


0 (0)


No. of regular antipsychotics Before
admission


1.1 ± 0.7


At discharge


1.7 ± 0.6