The use of academic detailing to improve evidence based prescribing of risperidone long acting injection

Objective. It takes 6 weeks for plasma levels of risperidone long-acting injection (RLAI) to reach steady state, and randomised controlled trials demonstrate a flat dose-response curve. In clinical practice, the dose of RLAI is often increased rapidly at the start of treatment and many patients receive a dose above 25 mg/2 weeks. We sought to understand why and to use academic detailing as a catalyst for change. Method. (1) Semi-structured interview of and academic detailing visit to psychiatrists. (2) Number of pharmacy issues or each strength of RLAI issues before and after the academic detailing visit. Results. Understanding of the pharmacokinetics of RLAI and the flat dose-response curve were poor. After a single visit from an academic detailer, the proportion of 50-mg doses issued decreased from 44 to 31%. Conclusion. Academic detailing was effective in changing prescribing practice; patients are likely to benefit through receiving treatment that has a better risk-benefit ratio, and the healthcare organization is likely to benefit, in terms of more cost-effective prescribing.