Utilization of Long-Acting Injectable Antipsychotics and Clozapine in Coordinated Specialty Care: Data From EPINET

Objective: We utilized the Early Psychosis Intervention Network (EPINET) platform to examine variability in utilization rates of 2 evidence-based pharmacologic treatments, long-acting injectable (LAI) formulations of antipsychotics and clozapine.

Methods: Data come from 8 EPINET clinic consortia, called "hubs," comprising a total of 113 clinics delivering coordinated specialty care (CSC). Hub rates of LAI and clozapine use were calculated based upon the number of patients who were prescribed LAIs or clozapine at any point in a patient's treatment during EPINET participation. Potential effects of demographic differences, including biological sex, race, and ethnicity, across hubs and sites on utilization were examined.

Results: Medication data, collected from September 2019 to June 2024, were available from 16,847 records with 5,324 participants. At the level of hubs, the proportion of patients receiving LAIs ranged from 5.0% to 37.5% and for clozapine 1.7% to 9.0%, and, at the clinic level, the proportion receiving LAIs ranged from 0.024 to 0.60 and for clozapine 0.005 to 0.33. We found very large standard deviations in both hub (0.61) and site (0.50) differences for LAIs, which remained large after adjustments for sex, ethnicity, and race. For clozapine prescribing, site differences were extremely large (0.92), while hub differences (0.37) were nonsignificant.

Conclusions: Pharmacological treatment practices regarding LAIs and clozapine are highly variable in US-based CSC programs. Higher adoption and patient reach through implementation strategies of these evidence-based practices might decrease the all-too-frequent occurrences of persistent positive symptoms, psychotic relapse, and hospitalization in early phase psychotic disorders.