Long-Acting Injectable Antipsychotics vs. Oral Antipsychotics in Treatment Adherence: Efficacy and Equity of Care

Summary Background: Compliance with oral antipsychotic medications (OAP) in the treatment of patients with schizophrenia has been a challenge. Challenges to OAP include medication side effects, lack of ability to obtain medications, and missing doses, among other factors. As a result of this non-compliance, those taking oral antipsychotic medication are at greater risk for exacerbation of their illness. The consequence of relapse carries considerable risks with each psychotic event. The study aims to compare if medication treatment adherence is greater in clients with schizophrenia using oral antipsychotics (OAPs) vs. long-acting injectable (LAI) antipsychotic medications. Methods: In this scoping review, 15 high-quality research articles were included for review. Articles were searched using the databases PubMed, EBSCO, and Medline. The search was conducted between August 2021 and November 2022, using specific keywords relevant to the background of the scoping review. Publication dates range from 2016-2022. Results: In this article, we examined and reviewed evidence-based research ranging in publication dates from 2016-2022. These studies revealed a wide range of benefits identifying LAIs as superior to OAPs in improving patient outcomes in clients diagnosed with schizophrenia. Evidence-based literature in this scoping review reports greater patient adherence to treatment with LAI vs. OAP. Conclusion: Treatment of schizophrenia can be challenging. LAI can be superior to OAP in the treatment of this disease. Treatment with LAI in clients with schizophrenia can lead to increased patient adherence, decreased ER visits, decreased length of hospital stay, hospitalizations, increased prescription fills, and increased quality of life

Intraoperative Administration Of An NSAID And An Opioid Vs. An Opioid Alone Effect On Postoperative Ileus Development

The purpose of this DNP project is to examine what is known from existing literature about postoperative ileus development in the adult surgical patient population after receiving intraoperative opioids versus a combination of intraoperative opioids and NSAIDs

Telehealth by Certified Psychiatric Providers Compared to Emergency Department Healthcare Providers on Psychiatric Patient Outcomes: A Scoping Review

Background: Emergency department visits for mental health disorders have increased over the years due to insufficient mental health resources. The number of ED visits for mental health disorders rose from 1.4 to 2.5 million per year in the US. Therefore, mental health patients being seen by ED physicians are more likely to have longer lengths of stay, an increase in hospital admission, and high recidivism rates. Purpose: In this scoping review, we wanted to determine the role of telehealth on ED mental health patients. outcomes regarding how telehealth can reduce the number of admissions, length of stay in the ED, dispositions of patients with mental illness complaints, the cost-effectiveness of telehealth, and patient and staff satisfaction were reviewed. Method: We collected data using The University of Tennessee Health Science Center (UTHSC) online Library, and we obtained articles using CINAHL Complete, Medline, and PubMed. The eligibility criteria were studies conducted in English, subjects greater than 18 years of age, meet DSM criteria for mental health diagnosis, and no limit on gender, race, and ethnicity. Participants must be able to consent. Result: Data from 11 articles published from 2012 to 2020 was collected. Decreased length of stay, improved patient outcomes, decreased healthcare cost, and reduction in readmission/revisit rates were the most frequently reported findings. Implications for Nursing Practice: Results of this scoping review showed improved patient outcomes and decreased readmission/revisit rates when patients with psychiatric illness were seen by a psychiatric physician via telehealth in the Emergency Department. This practice can be standardized and utilized to yield similar results to the literature review. Additional research is necessary to assist in the development of healthcare resources that will provide patients who suffer from mental illness with the care they deserve

Police Versus Non-Police Response to 988 Crisis Calls

Purpose/Background The 988 Suicide & Crisis Lifeline is a mental health-specific emergency line that became nationally available in July of 2022. This resource allows callers in crisis to connect with trained mental health professionals. Despite the initiation of this new dispatching service, there is still a significant shortage of trained mental health professionals to respond to these calls when they require emergency intervention. The present scoping review aims to determine whether non-police crisis responses correlate to improved outcomes when compared to police response as evidenced by reduced inpatient admissions, reduced arrests, and decreased presence of intrusive traumatic symptoms following intervention. Methods CINAHL and PubMed were searched using the University of Tennessee Health Science Center (UTHSC) library from September 2022 until November 2023. These search terms yielded 377 articles. Of those articles, only 335 were published in English, 200 were published after 2013, 198 had full-text publications available, and 21 were either a review or systematic review rather than an article or abstract. The remaining 21 articles were assessed using a Rapid Critical Appraisal tool. Ten articles remained after critical appraisal; the results of these articles were charted within the scoping review. Results This scoping review compared police versus non-police response to crisis calls. The synthesized results were obtained by critically appraising ten articles. This scoping review indicates that non-police response may result in the following improved patient outcomes: a decrease in involuntary hospital admission, arrest, and violence between the crisis caller and police. However, the shortage of quality experimental evidence limits the power of this indication. Implications for Nursing Practice The results of this scoping review indicate that non-police response to 988 calls may result in better patient outcomes. Due to this topic\u27s recency, nurses should advocate for more quality research to provide patients with the best possible evidence-based crisis response

Suicide Screening Among Adolescents with a History of Mental or Physical Abuse- Evaluating the Effectiveness of Suicide Screening: A Scoping Review

Purpose The purpose of this scoping review is to gather evidence on best practice for the administration of pediatric suicide screening in a variety of healthcare settings

Bi-Weekly Follow-Up of Adult Patients Diagnosed With Schizophrenia to Increase Treatment Adherence: A Scoping Review

Purpose/Background Schizophrenia is a complex psychiatric disorder that can significantly affect a patient’s psychological state. Because of this, medication nonadherence is reported as one of the most common causes of relapse and rehospitalization in patients diagnosed with schizophrenia. Although long-acting injectable (LAI) antipsychotics can help provide more continuous treatment, they do not address other factors that affect treatment adherence. This scoping review will evaluate existing literature to assess if a multimodal approach, such as increased patient follow-ups in addition to scheduled, current-practice LAI treatment and management, may increase treatment adherence in adult patients diagnosed with schizophrenia. Methods A database search was conducted using CINAHL, PubMed Clinical Queries, Cochrane Library, Sage, and Medline Ovid from the dates 2013-2022. Articles were chosen if they were based on scientific research involving human subjects and if they provided full free-text access. Both quantitative and observational studies were used to provide alternate perspectives on medication interventions and health outcomes. Results After conducting a systematic database search, 117 articles were selected, and after applying exclusion criteria, ten articles were chosen to be included in this scoping review. The articles illustrated that LAIs decrease hospital length of stay and increase treatment adherence, but multimodal approaches were not adequately examined to determine their effectiveness. Implications for Practice The results of this scoping review support that LAIs are generally superior to oral antipsychotics in the treatment of adult patients with schizophrenia. However, there is not enough literature to determine the effectiveness of bi-weekly follow-ups in combination with LAI treatment to increase treatment adherence in adults diagnosed with schizophrenia. The implementation of bi-weekly follow-ups for schizophrenic patients still holds promise, but more studies are required to evaluate the effectiveness of LAI treatments and accompanying interventions to increase treatment adherence

The Effect of Certified Diabetic Education on Hemoglobin A1C Levels in Patients with Type 2 Diabetes Mellitus

Purpose/Background Type 2 Diabetes Mellitus (T2DM) is a nationwide growing epidemic which contributes to hundreds of billions of dollars a year in healthcare costs and can lead to significant health complications, such as disability or death. To prevent these complications, patients must maintain adequate blood glucose control by adhering to their treatment plan and adopting healthy lifestyle behaviors, including dietary modifications and exercise. Through Certified Diabetes Educators (CDE) and PharmDs, patients can be educated on proper self-management techniques. Current evidence shows that CDEs helped improve Hemoglobin A1C (HbA1c) levels. Methods In this retrospective chart review, 29 charts of patients aged 18-65 diagnosed with T2DM who have received at least one diabetic education session from a PharmD/CDE were reviewed. Results Between January 1, 2019 and August 31, 2021, 29 patients met eligibility criteria. A two-tailed paired samples t-test revealed a decrease in mean HbA1c pre- and post-intervention from 9.50 (SD = 2.3) to 8.64 (SD = 2.34). However, results were not statistically significant based on an alpha value of 0.05, t(28) =1.89, p = .069. Implications for Nursing Practice While the data does not show a significant p-value, there was a detectable decrease in HbA1c in patients who were seen by a CDE. We believe this insignificant p-value was due to the low sample size and that a greater sample size would likely show more meaningful data. At this time, data demonstrates that the implementation of diabetic education, whether by a PharmD or CDE, is beneficial in the care of patients with T2DM

Monitoring Adherence to HCV Screening Among the Baby Boomer Population

Purpose/Background Chronic hepatitis C is currently the most common cause of liver disease in the United States and is associated with various complications that increase mortality and morbidity, yet many people go unidentified and thus untreated. The CDC created guidelines in 2012 for hepatitis C screening and testing among the baby boomer population due to their high rates of HCV infection and HCV-related mortality. Our project aimed to assess the adherence of hepatitis C screening, based on these CDC guidelines, of individuals within the baby boomer population (1945-1965) in the primary care setting through retrospective chart review. Methods A 6-month retrospective chart review was performed identifying any patients presenting to the primary care clinic who were born between the years 1945-1965. Charts were reviewed for whether or not hepatitis C screening tests were ordered on these patients. Results Thirty-one patients were identified based on our criteria and the average age of the individuals was 65.87 years old. Of these thirty-one patients, twenty-three (74%) were not screened for HCV and eight (26%) were screened for HCV. Implications for Nursing Practice The results provided in this retrospective chart review indicate that a substantial number of patients in the baby boomer population were not screened for HCV. Through adherence to recommended guidelines, an initial HCV screen for every patient can significantly improve the identification and treatment of Hepatitis C in infected individuals

Annual Hepatitis C Screening QI: A Scoping Review

Purpose/Background Despite the surge in HCV prevalence among pregnant women and the threat of perinatal HCV transmission, infants exposed to HCV in the United States are inadequately screened (Chappell et al., 2018). It is estimated that between 4% and 8% of babies exposed to HCV during pregnancy become infected (Watts et al., 2017). Incorporating Hep C screening with other mandated prenatal screening will play an essential role in reducing the complications associated with Hep C transmission to the newborn. Methods Article search was done in the first three weeks of the fall 2021 semester, and a total of 63 articles were screened to exclude those that only focused on men (N=2) and women who were not pregnant (N=5). Six final articles were selected for scoping review, comparing the outcomes of women between 18 and 35 years of age who were at high risk of HCV and who received prenatal HCV screening to those who were not screened. The study further explores the health outcome associated with early detection of HCV in high-risk pregnant women and the vertical transmission rate from mother to newborn baby. Results According to the reviewed studies, early screening and prompt treatment during pregnancy can prevent most mother-to-child transmissions and thus most childhood cases of HCV. Interventions and outcomes noted in the articles selected are to increase screening in infants at risk for perinatal HCV acquisition by including technology to improve the transfer of maternal HCV status to the pediatric record and increase pediatric provider awareness regarding HCV screening guidelines. Implications for Nursing Practice The studies demonstrate that universal HCV screening is efficient, cost-effective, and beneficial when long-term needs are present (Baranoski, 2016). Following the recommendations, universal HCV screening with HCV antibodies and reflex HCV RNA testing may soon become standard practice in the United States. Therefore, it is imperative to review and incorporate this into the curriculum and training proactively. References Baranoski, A. S., Cotton, D., Horsburgh, C. R., Kubiak, R. W., Heeren, T., Nunes, D. (2016). Clinical liver disease progression among hepatitis C infected drug users with CD4 cell count less than 200 cells/mm3 is more pronounced among women than men. Open Forum Infectious Diseases, 3(1). https://doi-org.ezproxy.uthsc.edu/10.1093/ofid/ofv214. Chappell, C. A., Hillier, S. L., Crowe, D., Meyn, L. A., Bogen, D. L., & Krans, E. E. (2018). Hepatitis C Virus Screening Among Children Exposed During Pregnancy. Pediatrics, 141(6), e20173273. https://doi.org/10.1542/peds.2017-3273. Watts, T., Stockman, L., Martin, J., Guilfoyle, S., & Vergeront, J. M. (2017). Increased Risk for Mother-to-Infant Transmission of Hepatitis C Virus Among Medicaid Recipients - Wisconsin, 2011- 2015. MMWR. Morbidity and mortality weekly report, 66(42), 1136–1139. https://doi.org/10.15585/mmwr.mm6642a

LAI Antipsychotics vs. Oral Antipsychotics: Treatment adherence, Relapses, and Readmissions

Purpose/Background Schizophrenia is a lifelong illness with recurrent and often debilitating symptoms that may impair daily functioning, cognition, behaviors, socialization, emotions, and expression. It is recognized as a global mental health burden that affects the individual, their family, and society. Medication nonadherence and resulting relapse detrimentally affect the patient’s physical and mental health and quality of life. They are associated with increased hospitalization and emergency room visits, substance use, suicide, and homelessness. Current guidelines endorse second-generation antipsychotics such as Risperidone and Aripiprazole as the first-line treatment for most cases of psychosis. However, long-acting injectable (LAIs) atypical antipsychotics are a promising alternative to overcome noncompliance in treating Schizophrenia and help increase treatment adherence, decrease the likelihood of discontinuation, and provide better symptom management. The purpose of this project is to assess the benefits long-acting injectable antipsychotics have on treatment adherence, decreased re-hospitalizations, and relapses for treating individuals with schizophrenia. Methods This retrospective chart review was performed at Vanderbilt Adult Psychiatry Outpatient Clinic (VPH-OP) via electronic database access by an EMR Analysts (EStar), where participants were selected based on inclusion criteria for the long-acting injectables group and the oral antipsychotic group. Inclusion criteria included current establishment as a patient at the VPH-OP Clinic, greater than 18 years of age, a diagnosis of schizophrenia spectrum disorders and bipolar disorders per the DSM-5, and current treatment with antipsychotic medication. Participants who met criteria based on medication were randomized into the long-acting injectable group (n-15) and oral antipsychotic group (n=15). Data was collected in the Redcap data collection tool for deidentification and included age, race, gender, diagnosis, oral or long-acting injectable medication, missed appointments, in-patient hospitalizations, and whether the medication was changed, maintained, or discontinued. Data was collected from October 1, 2022, to October 31, 2023. The study was approved by the respective Institutional Review Boards. Results The study showed that there is no significant difference in inpatient hospitalization between oral antipsychotics and long-acting antipsychotics. 3 out of 15 LAIs compared to 3 out of 15 oral antipsychotics participants had inpatient hospitalizations. The study showed a slight significant difference in medication changes, discontinuation, and missed medication appointments. In 3 out of 15 LAIs compared to 4 out of 15 oral antipsychotic participants, medication was changed or discontinued. 9 out of 15 LAIs compared to 10 out of 15 oral antipsychotics out of 15 LAIs compared to 10 out of 15 oral antipsychotics participants missed medication appointments. Implications for Nursing Practice The study shows there are some beneficial aspects to using LAIs compared to oral antipsychotics. Future studies with a larger sample size would be beneficial to evaluate treatment adherence and examine statistical differences between LAIs and oral antipsychotics in patients with schizophrenia. Adherence to treatment for schizophrenia has been a difficult task due to the complicated symptomology of side effects associated with antipsychotic medications. Continuous studies to find the most efficient medications are imperative to help advance the treatment of individuals with schizophrenia