Effects of a pharmacist-led GAIN approach on long-acting injectables in schizophrenia

Long-acting injectable antipsychotics (LAIs) effectively prevent relapse in patients with schizophrenia; however, their utilization rate remains markedly lower in Japan than in other countries.

To quantitatively evaluate the effectiveness of a pharmacist-led Goalsetting, Action planning, Initiating treatment, Nurturing motivation (GAIN) approach on the initiation and persistence of LAI therapy in Japan has yet to be quantitatively evaluated.

This retrospective observational cohort study examined the effectiveness of the GAIN approach, a structured communication tool led by ward pharmacists to facilitate LAI initiation. We analyzed 180 patients with schizophrenia admitted to our hospital between April 2018 and March 2023 for whom LAI treatment was considered. Outcomes were compared between an intervention group (n = 79), in which pharmacists implemented the GAIN approach, and a nonintervention group (n = 101), in which physicians provided conventional oral explanations.

The LAI initiation rate was significantly higher in the intervention group than in the nonintervention group (86.1% vs. 59.4%, P < 0.010). Furthermore, the primary endpoint of 1-year LAI persistence was significantly higher in the intervention group (88.2% vs. 61.7%, P < 0.010). Within the intervention group, Drug Attitude Inventory-10 and Schedule for Assessment of Insight-Japanese version scores showed significant improvements following the intervention (P < 0.010).

These results suggest that a pharmacist-led GAIN approach improves patients' insight and medication attitudes, facilitating both the initiation and long-term maintenance of LAI therapy. In the context of burdened clinical settings, pharmacist involvement via task shifting represents an effective strategy for optimizing psychiatric pharmacotherapy.