Use of Long-Acting Injectables Versus Oral Antipsychotics Among Indigent Populations: A Systematic Review [paper]




Ryan, Brooke

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Introduction: Schizophrenia affects approximately 3,810,000 people in the United States and is estimated to cost $155.7 billion. It increases unemployment and poverty, and it is estimated that as much as 25% of the homeless population has schizophrenia. The first line of treatment for schizophrenia is an antipsychotic medication which comes in two available formulations, long-acting injectable antipsychotics (LAIAs) or oral antipsychotics (OAs). Long-acting injectable antipsychotics in the treatment of schizophrenia have been shown to improve adherence to treatment, psychosocial outcomes, criminal behavior, and relapse prevention, compared to oral medication. Long acting injectables are rarely offered by providers or considered as treatment options after a patient’s first episode. This conflict between scientific evidence and clinical practice prompted this systematic review which examines the cost and effectiveness of the use of long-acting injectable antipsychotics compared to oral antipsychotic medication in indigent populations. Methods: Search dates were between 2012 and 2022. Search terms were “long-acting injectables,” “schizophrenia,” “homeless,” “oral medication,” and “cost.” Databases used were PubMed, CINAHL, and Medline. Results: Themes found across the studies were that LAIAs improved adherence to medication, reduced ER visits, decreased cost, improved housing stability, and were under prescribed. Discussion: More research needs to be done on using LAIAs, especially among indigent populations. Providers should get involved in local and statewide politics to advocate for indigent patients. Clinical practice guidelines should be updated more regularly and should include patient’s needs on a social services level.



schizophrenia, long acting injectables, oral antipsychotics, homeless, cost, Nursing


Ryan, B. (2022). Use of long-acting injectables versus oral antipsychotics among indigent populations: A systematic review [Report]. St. David's Nursing School, Texas State University.


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