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Evaluating patient satisfaction with pharmacist-administered long-acting injectable antipsychotics in the community pharmacy

      Abstract

      Objective

      To evaluate patient satisfaction with pharmacist-administered long-acting injectable antipsychotics (LAIAs) in the community pharmacy.

      Design

      Prospective survey.

      Setting

      Albertsons Companies community pharmacies during December 2016 to February 2017.

      Participants

      Patients receiving LAIAs at participating pharmacies.

      Main outcome measures

      A survey assessed patients’ satisfaction with pharmacist-administered LAIAs in the community pharmacy.

      Results

      LAIA recipients (N = 104) reported satisfaction with community pharmacist-administered LAIAs. Participants who had received the service at other types of health clinics (N = 57) also reported higher satisfaction with current service compared to a similar service received elsewhere. Participants indicated that they would recommend service to others and that service was more convenient than a similar service received in an alternative setting. There was not a statistically significant relationship between patient demographic characteristics and likelihood of recommending service to others.

      Conclusion

      Patients were satisfied with a pharmacist-administered LAIA service in the community pharmacy, and they found it more convenient than similar services provided elsewhere.

       Background

      • Long-acting injectable antipsychotics have been shown to have improved adherence compared with oral antipsychotics.
      • Increasing access to mental health care services is important for improving patient outcomes and decreasing health care costs.
      • Studies assessing patient satisfaction with LAIAs administered in the community pharmacy are lacking.

       Findings

      • Patients were satisfied with the pharmacist-administered long-acting injectable antipsychotics service provided in the community pharmacy.
      • Those who received a similar service at another health clinic were just as satisfied with the pharmacy-administered long-acting injectable antipsychotics in the community pharmacy.
      Schizophrenia is a chronic mental illness that affects an estimated 1% of the population worldwide.
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      Schizophrenia is diagnosed in approximately 1.5 per 10,000 people annually.
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      Schizophrenia affects more men than women (1.4:1 ratio) with a typical onset during adolescence.
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      Schizophrenia: a concise overview of incidence, prevalence, and mortality.
      Bipolar disorder is another chronic mental illness that affects young adults with an estimated global prevalence of 2.4%.
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      • He J.P.
      • et al.
      Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative.
      Bipolar disorder affects men and women in similar proportions.
      • American Psychiatric Association. Bipolar and related disorders
      Diagnostic and Statistical Manual of Mental Disorders.
      If not managed properly, these mental illnesses are linked to numerous negative consequences, including decreased quality of life and increased burden on the health care system. In 2013, schizophrenia was estimated to create an economic burden of $155.7 billion in the United States.
      • Cloutier M.
      • Aigbogun M.S.
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      • et al.
      The economic burden of schizophrenia in the United States in 2013.
      Bipolar disorder is the eighteenth leading cause of disability in the United States, placing this illness ahead of chronic kidney disease and stroke.
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      The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.
      Adherence to prescribed medications is important to improve outcomes; however, more than 40% of patients affected by schizophrenia or bipolar disorder are not adherent to their medications.
      • Ascher-Svanum H.
      • Zhu B.
      • Faries D.E.
      • Lacro J.P.
      • Dolder C.R.
      • Peng X.
      Adherence and persistence to typical and atypical antipsychotics in the naturalistic treatment of patients with schizophrenia.
      • García S.
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      • et al.
      Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: a systematic review.
      Poor adherence to antipsychotics has been associated with higher risk of relapse, hospitalization frequency, and costs.
      • Sun S.X.
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      • Christensen D.B.
      • Fu A.Z.
      Review and analysis of hospitalization costs associated with antipsychotic nonadherence in the treatment of schizophrenia in the United States.
      • Hassan M.
      • Lage M.J.
      Risk of rehospitalization among bipolar disorder patients who are nonadherent to antipsychotic therapy after hospital discharge.
      One way to improve adherence is by using long-acting injectable antipsychotics (LAIAs). Medication adherence has been shown to be greater with LAIAs compared with oral antipsychotics in patients affected by schizophrenia and in those affected by bipolar disorder.
      • Lin J.
      • Wong B.
      • Offord S.
      • Mirski D.
      Healthcare cost reductions associated with the use of LAI formulations of antipsychotic medications versus oral among patients with schizophrenia.
      • Greene M.
      • Yan T.
      • Chang E.
      • Hartry A.
      • Touya M.
      • Broder M.S.
      Medication adherence and discontinuation of long-acting injectable versus oral antipsychotics in patients with schizophrenia or bipolar disorder.
      In addition to improved adherence, LAIAs possess several advantages over oral antipsychotics, such as increased dosing interval, decreased relapse rates, and improved patient outcomes.
      • Lin J.
      • Wong B.
      • Offord S.
      • Mirski D.
      Healthcare cost reductions associated with the use of LAI formulations of antipsychotic medications versus oral among patients with schizophrenia.
      • Brissos S.
      • Veguilla M.R.
      • Taylor D.
      • Balanzá-Martinez V.
      The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal.
      The medication possession ratios for patients receiving LAIAs are higher compared with oral antipsychotics.
      • Lin J.
      • Wong B.
      • Offord S.
      • Mirski D.
      Healthcare cost reductions associated with the use of LAI formulations of antipsychotic medications versus oral among patients with schizophrenia.
      Overall, treatment with LAIAs was associated with decreased health care costs even though drug costs are higher.
      • Lin J.
      • Wong B.
      • Offord S.
      • Mirski D.
      Healthcare cost reductions associated with the use of LAI formulations of antipsychotic medications versus oral among patients with schizophrenia.
      • Pesa J.A.
      • Muser E.
      • Montejano L.B.
      • Smith D.M.
      • Meyers O.I.
      Costs and resource utilization among Medicaid patients with schizophrenia treated with paliperidone palmitate or oral atypical antipsychotics.
      Compared with patients taking oral antipsychotics, patients receiving LAIAs have lower mean inpatient costs and hospitalization rates and fewer inpatient days.
      • Baser O.
      • Xie L.
      • Pesa J.
      • Durkin M.
      Healthcare utilization and costs of Veterans Health Administration patients with schizophrenia treated with paliperidone palmitate long-acting injection or oral atypical antipsychotics.
      Studies have found a reduction in outpatient costs for schizophrenia-related services and services for any cause; however, these findings were not replicated by other studies.
      • Lin J.
      • Wong B.
      • Offord S.
      • Mirski D.
      Healthcare cost reductions associated with the use of LAI formulations of antipsychotic medications versus oral among patients with schizophrenia.
      • Chang H.C.
      • Tang C.H.
      • Huang S.T.
      • McCrone P.
      • Su K.P.
      A cost-consequence analysis of long-acting injectable risperidone in schizophrenia: a one-year mirror-image study with national claim-based database in Taiwan.
      Typically, patients receive LAIAs in a mental health clinic setting. Administration of LAIAs in a mental health clinic has some inconveniences, including limited hours of operation, availability in rural areas, and increased stigma, such as experiencing perceived social rejection.
      • Corrigan P.
      How stigma interferes with mental health care.
      • Jacob K.S.
      • Sharan P.
      • Mirza I.
      • et al.
      Mental health systems in countries: Where are we now?.
      • Jagdeo A.
      • Cox B.J.
      • Stein M.B.
      • Sareen J.
      Negative attitudes toward help seeking for mental illness in 2 population-based surveys from the United States and Canada.
      • U.S. Department of Health and Human Services
      Mental Health: A Report of the Surgeon General.
      • World Health Organization
      World Health Report 2001. Mental Health: New Understanding, New Hope.
      • Ziller E.C.
      • Anderson N.J.
      • Coburn A.F.
      Access to rural mental health services: service use and out-of-pocket costs.
      However, LAIAs can be administered in a community pharmacy setting when specific criteria are met. Potential benefits of receiving LAIAs at a community pharmacy site include increased patient accessibility with extended hours of operation, multiple locations, and decreased stigma, because patients can visit a community pharmacy for a wide variety of services and not just for a mental health appointment. The American Pharmacists Association (APhA) recently released a report supporting pharmacist involvement in administration of long-acting injectable medications including LAIAs.
      • Skelton J.B.
      • Rothholz M.C.
      • Vatanka P.
      Report of the APhA Stakeholder Conference on Improving Patient Access to Injectable Medications.
      APhA also provides practice guidance for pharmacy-based medication administration, such as practice development, program structure, education and training, and legal authority.
      • American Pharmacists Association
      Practice Guidance for Pharmacy-Based Medication Administration Services. Washington, DC: APhA; 2017.
      To the authors’ knowledge, studies that review LAIA administration in the community pharmacy are lacking. This study aims to evaluate patient satisfaction with LAIAs administered in the community pharmacy. Understanding whether patients who receive LAIAs in the community pharmacy as an alternative to health clinics are satisfied with the service is an important first step to expanding access to mental health services.

      Objectives

      The primary objective of this study was to evaluate patient satisfaction with pharmacist-administered LAIAs in the community pharmacy. The secondary objectives of this study were to evaluate patient satisfaction with current service compared to a similar service received elsewhere and to determine the relationship between patient demographic characteristics and likelihood of recommending service to others.

      Methods

       Study design and study period

      This study used a prospective survey design that was approved by the Regis University Investigational Review Board. The survey assessing patient satisfaction was provided to adults receiving LAIAs administered by a pharmacist in a community pharmacy from December 12, 2016, until February 6, 2017.

       Practice setting

      Albertsons Companies provides a pharmacist-administered LAIA service as part of a Specialty Care program in select community pharmacies in 9 different states. This service became available approximately 7 years ago. Local mental health clinics refer patients to this service. Administration of these medications is coordinated by the company’s Specialty Care team. Company pharmacists administer medications by “prescription to administer” from a provider with prescriptive authority. As of October 2016, approximately 450 pharmacists in the organization were trained to administer LAIAs, including aripiprazole (Abilify Maintena; Otsuka America Pharmaceutical), aripiprazole lauroxil (Aristada; Alkermes), fluphenazine, haloperidol decanoate, paliperidone palmitate (Invega Sustenna, Invega, Trinza, Janssen Pharmaceuticals), and risperidone (Risperdal Consta; Janssen Pharmaceuticals).
      Criteria set by Albertsons Companies for community pharmacist–administered LAIAs include completion of company-approved immunization training, LAIA administration training, blood-borne pathogen training, cardiopulmonary resuscitation training, established medication-specific protocols, established adverse reaction protocol, readily retrievable emergency kit, and private areas for injection administration.
      Pharmacists complete a company-approved immunization training program and a manufacturer-specific LAIA training to be certified for LAIA administration. The Specialty Care team notifies the administering pharmacist when a patient requests administration of a LAIA. Injections are provided by appointment and may be administered during all operating hours of the pharmacy. The store team staffs the pharmacy appropriately according to the number of appointments for the given day.
      Appointments are approximately 30 minutes in duration and are conducted in a private space that is dedicated to patient care. A consent form for medication administration, which lists some of the steps involved in medication administration, and a drug information statement for the medication to be administered are provided to the patient upon arrival for an appointment. The administering pharmacist reviews the questions on the medication administration protocol with the patient, including adverse effects associated with the medication administered, and documents the responses. After preparing the medication in the patient’s presence, the pharmacist administers the LAIA using aseptic technique. The patient remains seated for 15 minutes for monitoring of adverse reactions. The pharmacist completes the remainder of the consent form for medication administration, including medication information and site of injection. A notification form is faxed to the physician within 48 hours of administration. Adverse reactions are reported to the patient’s mental health clinic and the manufacturer, if required. An estimated 500 patients participate currently in this service each month.

       Survey development procedures

      The Patient Satisfaction Questionnaire-18, the Treatment Satisfaction Questionnaire for Medication, the Client Satisfaction Questionnaire-18 and -8, and previous studies assessing patient satisfaction in general and with psychiatric services specifically were used to derive the patient satisfaction survey.
      • Holikatti P.C.
      • Kar N.
      • Mishra A.
      • Shukla R.
      • Swain S.P.
      • Kar S.
      A study on patient satisfaction with psychiatric services.
      • Kwon J.S.
      • Kim S.N.
      • Han J.
      • et al.
      Satisfaction of immediate or delayed switch to paliperidone palmitate in patients unsatisfied with current oral atypical antipsychotics.
      • Attkisson C.C.
      • Zwick R.
      The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome.
      The 2-page survey developed for this study was customized to evaluate specific satisfaction areas of interest by the investigators. The goal of the survey was to assess specific aspects of care related to patients receiving LAIAs in the community pharmacy setting, and using the scope of the validated surveys would have been too broad for this service. For example, questions related to financial barriers and accuracy of diagnosis made by a provider were not included.
      The survey assessed patient satisfaction using a 5-point Likert scale (1, strongly disagree, to 5, strongly agree), included both positive and negative statements, and gathered demographic information (Appendix 1). The survey contained 4 sections. Section 1 assessed satisfaction in 11 areas: level of privacy, convenience of scheduling appointments, convenience of location, comfort with service provided by pharmacy, confidence in pharmacist’s ability to administer the medication, trust in pharmacist, pharmacist communication, pharmacist listening skills, pharmacist knowledge about service, duration of appointment, and likelihood of recommending service to others. Section 2 was optional and featured open-ended items where participants could state what they enjoyed about current service and how it could be improved. Section 3 assessed comparison of current service to a similar service previously received in an alternative setting (e.g., mental health clinic) if applicable. Section 4 gathered the following demographic information: age, sex, state of residence, number of years with current condition, and number of months using current service. Patients were not asked to report a specific age in years on the survey. Patients reported age as categorical data in the following ranges: 18-20, 20-39, 40-64, and 65+. They were asked to report age in a category to make the survey as simple as possible to complete. The results were reported as younger than or older than 40 years of age in the results section (Table 1), because younger age has been recognized as a predictor of poor adherence in a systematic review that evaluated risk factors associated with antipsychotic nonadherence in patients with schizophrenia and bipolar disorder.
      • García S.
      • Martínez-Cengotitabengoa M.
      • López-Zurbano S.
      • et al.
      Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: a systematic review.
      Improved adherence was reported after the age of 41 years in patients with bipolar disorder.
      • García S.
      • Martínez-Cengotitabengoa M.
      • López-Zurbano S.
      • et al.
      Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: a systematic review.
      A similar age was used in this study to determine whether there was a correlation between age and likelihood of recommending service to others. This survey was not validated.
      Table 1Baseline characteristics
      Characteristicsn (%)
      Percentage total does not add exactly to 100% because of rounding.
      State of residence (N = 104)
       Arizona3 (2.9)
       California24 (23.1)
       Colorado0 (0.0)
       Hawaii1 (1.0)
       Idaho3 (2.9)
       Oregon7 (6.7)
       Texas47 (45.2)
       Virginia3 (2.9)
       Washington16 (15.4)
      Age group (N = 104)
       <40 years old65 (62.5)
       ≥40 years old39 (37.5)
      Sex
      Two patients opted not to answer.
      (n = 102)
       Female36 (35.3)
       Male66 (64.7)
      Number of years with current condition
      Four patients opted not to answer.
      (n = 100)
       <18 (8.0)
       1–549 (49.0)
       6–1015 (15.0)
       >1028 (28.0)
      Number of months using this service
      Three patients opted not to answer.
      (n = 101)
       <15 (5.0)
       1–625 (24.8)
       7–1224 (23.8)
       13–1814 (13.9)
       19–2412 (11.9)
       >2421 (20.8)
      a Percentage total does not add exactly to 100% because of rounding.
      b Two patients opted not to answer.
      c Four patients opted not to answer.
      d Three patients opted not to answer.
      The Specialty Care team faxed the survey to the administering pharmacist. The administering pharmacist provided a paper copy of the faxed survey to the participants interested in taking part in the study after LAIA administration. Patients were invited to complete the survey after the pharmacist administered the LAIA. Survey completion was voluntary and anonymous. The administering pharmacist faxed the completed survey to the primary investigator.

       Participants

      Administering pharmacists were asked to invite all adults receiving aripiprazole (Abilify Maintena; Otsuka America Pharmaceutical), paliperidone palmitate (Invega Sustenna, Invega Trinza; Janssen Pharmaceuticals), and risperidone (Risperdal Consta; Janssen Pharmaceuticals) at a participating pharmacy to complete the survey. Participants were included if they were 18 years of age or older. Participants who were younger than 18 years, those who received LAIAs other than the LAIAs listed in the inclusion criteria, and those who declined to complete survey were excluded from the study. Over the course of 8 weeks, 716 surveys were faxed to administering pharmacists. The administering pharmacist provided a paper copy of the faxed survey to the participants interested in taking part in the study after LAIA administration.

       Data collection and analyses

      Descriptive statistics (frequencies) were used to report patient satisfaction. Pearson chi-square analysis was used to evaluate the relationship between patient satisfaction and demographic factors (age, sex, state of residence). A sample size calculator from the Creative Research Systems survey software was used to estimate a sample size of 217 responses needed to have 95% certainty with a 5% margin of error. Microsoft Excel was used to collect and analyze the descriptive data.

      Results

      Seven hundred sixteen surveys were distributed during the study period, and 158 were returned. The response rate was 22.1%. The following factors may have affected the number of returned surveys: administering pharmacists did not receive the survey, administering pharmacists did not inform the principal investigator of declined surveys, and the principal investigator might not have received surveys faxed by administering pharmacists if transmission errors occurred. Of the surveys collected, 54 surveys were excluded because of incomplete data, data not transmitted clearly, and duplicate surveys. The excluded surveys included 11 refused patient surveys. Patient satisfaction was analyzed for the remaining 104 surveys. Of the remaining surveys, 57 participants received LAIAs in an alternate setting and compared the current service to previous settings.
      Participant demographics are summarized in Table 1. The majority of the participants were located in Texas, followed by California and Washington. More than 60% of the participants were male and younger than 40 years of age. More than half of the participants had the indicated condition for 5 years or less and had been using the current service for 12 months or less. Overall, patient satisfaction with the service was high (Table 2).
      Table 2Patient satisfaction and service comparison
      StatementPositive responses (n, %)Neutral responses (n, %)Negative responses (n, %)
      Patient satisfaction (N = 104)
       Level of privacy102 (98.1)2 (1.9)0 (0.0)
       Ease of scheduling appointment89 (85.6)7 (6.7)8 (7.7)
       Comfort with service provided by pharmacy102 (98.1)1 (0.9)1 (0.9)
       Convenience of location67 (64.4)20 (19.2)17 (16.3)
       Trust in pharmacist100 (96.1)3 (2.9)1 (0.9)
       Clear pharmacist communication98 (94.2)1 (0.9)5 (4.8)
       Pharmacist listening skills101 (97.1)3 (2.9)0 (0.0)
       Confidence in pharmacist’s ability to administer medication102 (98.1)2 (1.9)0 (0.0)
       Pharmacist knowledge about service provided101 (97.1)3 (2.9)0 (0.0)
       Unrushed appointment100 (96.1)2 (1.9)2 (1.9)
       Likelihood of recommending service to others97 (93.3)5 (4.8)2 (1.9)
      Service comparison (n = 57)
       I trusted the RPh as much or more53 (93.0)4 (7.0)0 (0.0)
       The RPh communicated the process as clearly51 (89.5)2 (3.5)4 (7.0)
       The RPh was as knowledgeable or more44 (77.2)11 (19.3)2 (3.5)
       The RPh listened as carefully53 (93.0)4 (7.0)0 (0.0)
       This service was more convenient
      One patient opted not to answer (n = 56).
      46 (82.1)5 (8.9)5 (8.9)
      Abbreviation used: RPh, registered pharmacist.
      a One patient opted not to answer (n = 56).
      More than 98% of the participants agreed or strongly agreed that they were satisfied with the level of privacy and felt comfortable with the experience. Almost 86% of the participants reported that it was convenient to schedule an appointment; however, just over one-third of participants thought that the service was not close to home or work. More than 96% of participants agreed or strongly agreed that they trusted the pharmacist administering the LAIA. More than 94% of participants indicated that the pharmacist communicated clearly. Approximately 97% of participants believed that the administering pharmacist listened to them carefully. Nearly all participants were confident in the pharmacist’s ability to administer the LAIA and knowledge about the service provided. More than 96% of participants did not feel rushed during the appointment. Above all, more than 93% of participants agreed or strongly agreed that they would recommend the service to others.
      One of the secondary objectives of the study was to evaluate patient satisfaction with the current service compared with a similar service received elsewhere (Table 2). Nearly 93% of the participants indicated that they trusted the pharmacist as much or more than the person who provided a similar service in a different setting and that the pharmacist listened as carefully as other health care professionals. More than 89% of participants believed that the pharmacist communicated the process as clearly as other health care professionals did. More than 77% of the participants agreed or strongly agreed that the pharmacist was as or more knowledgeable about the service than other health care professionals who provided a similar service in an alternative setting. Most importantly, nearly 81% of the participants agreed or strongly agreed that this service was more convenient than a similar service received in an alternative setting.
      Another secondary objective of the study was to evaluate the relationship between patient demographic characteristics and likelihood of recommending service to others. Because of the overall small sample size, statistical significance was not reached for any of the demographic characteristics evaluated. The relationship between age and likelihood of recommending service to others was not significant (P = 0.19). Likewise, the relationship between sex and likelihood of recommending service to others was not significant (P = 0.23). Lastly, to evaluate the relationship between state of residence and likelihood of recommending service to others, the states of California and Texas were used for statistical analysis because of a more robust participant representation in those states. Similar to age and sex, no relationship was found between state of residence and likelihood of recommending service to others (P = 0.20 for California and P = 0.36 for Texas).
      Participants who completed the optional open-ended statement section remarked how much they appreciated availability of service. Positive feedback provided by participants included, but was not limited to pharmacist empathy, rapport and professionalism, less crowded environment, flexibility of scheduling, convenience, and proximity. Overall, the participants did not report feedback concerning service improvement.

      Discussion

      To the authors’ knowledge, this is the first study to evaluate patient satisfaction with pharmacist-administered LAIAs in the community pharmacy setting. Overall, participants were greatly satisfied with the community pharmacist–administered LAIA service including level of privacy, ease of scheduling an appointment, comfort with service, duration of appointment, location of service, pharmacist communication, and clinical skills. More than 93% of the participants would recommend the community pharmacist–administered LAIA service to others. Nearly 81% of the participants reported that receiving LAIAs in the community pharmacy was more convenient compared with receiving LAIAs in other health clinics. No relationship was found between patient demographic characteristics and likelihood of recommending service to others.
      In a 2007 survey conducted by the Substance Abuse and Mental Health Services Administration and the Centers for Disease Control and Prevention, only 57% of the respondents believed that people are caring and sympathetic to those affected by mental illness.
      • Centers for Disease Control and Prevention
      Attitudes toward mental illness–35 states, District of Columbia, and Puerto Rico, 2007.
      Study participants remarked how much they valued the empathy and listening skills demonstrated by the pharmacist. Gaining patients’ trust and developing rapport are pertinent to improving adherence rates to these vitally important medications.
      • García S.
      • Martínez-Cengotitabengoa M.
      • López-Zurbano S.
      • et al.
      Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: a systematic review.
      This study did not evaluate adherence rates or relation between satisfaction and adherence; this could be an area of future study.
      The findings in this study suggest that having the option to receive community pharmacist–administered LAIAs has various benefits for patients affected by mental illness and their caregivers, including convenience of location, scheduling appointments at a more opportune time, and quality of appointments. For these reasons, pharmacist-administered LAIAs in the community pharmacy can greatly increase access to mental health service, especially in rural or remote areas. Furthermore, community pharmacies have longer hours of operation during the weekdays and are generally open over the weekend and during holidays. The option of having access to a variety of locations and extended hours of operation to receive LAIAs further provides a more seamless integration of these medications within a patient’s lifestyle. Despite this option, a lower-than-expected percentage of patients (67/104; 64%) indicated satisfaction with the location of the service. A possible explanation for approximately one-third of the group having a negative or neutral response related to location would be that although there are more pharmacies than clinics that provide mental health service, the pharmacy that offered the service might still have been farther away than the patient’s usual pharmacy location.
      APhA supports pharmacist-administered LAIAs.
      • Skelton J.B.
      • Rothholz M.C.
      • Vatanka P.
      Report of the APhA Stakeholder Conference on Improving Patient Access to Injectable Medications.
      In an APhA Stakeholder report, pharmacists are encouraged to review state specific scope of practice and advocate for reform if administration of injectable medications is not part of a pharmacist’s scope. Training additional pharmacists to administer LAIAs in the community pharmacy and also passing legislation in states where pharmacists are not allowed to administer LAIAs can further increase access to mental health services and positively affect quality of life. As of November 2016, pharmacist administration authority for LAIAs was as follows: allowed in 28 states, allowed with a collaborative practice agreement in 8 states, not allowed in 14 states, and unclear in 1 state. Albertsons Companies aims to work with state boards of pharmacy to add medication administration to pharmacists’ scope of practice. The LAIA service, similar to other clinical pharmacy services, was piloted in certain regions, and it may be expanded on the basis of need and best practices to other sites in states where pharmacists have the authority to administer LAIAs.
      The respondents received the service at one of the community pharmacies where training is standardized for administering pharmacists. If other community pharmacies were to implement a similar service, a standardized model should be used to maintain a high level of patient satisfaction. The outline for training requirements and protocol inclusions described in the background section of this article, state-specific rules, and the recommendation and guidance provided by APhA can be used to develop a standardized model.
      • American Pharmacists Association
      Practice Guidance for Pharmacy-Based Medication Administration Services. Washington, DC: APhA; 2017.
      The study had a limited sample size with respondents located primarily in 3 states in the western half of the United States, and the desired sample size was not achieved. The satisfaction survey was developed by the primary investigator and coinvestigators and was not validated. Although the survey included both positive and negative statements in an effort to reduce bias, it contained more positive than negative statements. Responses to the mixed positive and negative statements may have been skewed if the participants had cognitive impairment, which is sometimes present in patients with schizophrenia. With survey research, response bias may be present. In addition, the data were self-reported by participants. There was the possibility of participants completing the survey more than once, although this was unlikely.
      Future research should continue to assess patient satisfaction with pharmacist-administered LAIAs in the community pharmacy and how satisfaction may affect other clinical outcomes. Further detailing patient demographic characteristics, such as employment status and living arrangements, to improve patient care is warranted. Research should also assess adherence in patients receiving LAIAs in the community pharmacy compared with an alternative setting and whether receiving an LAIA in a community pharmacy reduces stigma.

      Conclusion

      Overall, participants were satisfied with the community pharmacist–administered LAIA service. Likewise, patients who previously received an LAIA at another health clinic were equally satisfied with pharmacist trust, knowledge, and communication skills. Participants rated this service as being more convenient than a similar service received elsewhere. No relationship was found between age, sex, or state of residence and patient likelihood of recommending service to others because of the small sample size. The results of this study are instrumental in expanding and increasing access to mental health services. Additional research is needed for further assessment of patient satisfaction with pharmacist-administered LAIAs in the community pharmacy and its impact on adherence or other outcomes.

      Acknowledgment

      The authors thank Robert Haight, PhD, for contributions to the data analysis.

      Appendix

      Please take a few minutes to fill out this survey on the satisfaction of the service you received today. We welcome your feedback and your answers will be kept confidential. Thank you for your participation.
      Section 1
      Tabled 1
      Please circle one number on each line.Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
      1. I was satisfied with the amount of privacy during this service.12345
      2. It was difficult to schedule an appointment at a time that was convenient to me.12345
      3. I felt comfortable with the experience provided by the pharmacy.12345
      4. This service was not in close proximity to my home/work.12345
      5. I trusted the pharmacist who provided this service today.12345
      6. The pharmacist did not communicate clearly.12345
      7. The pharmacist listened carefully to what I had to say.12345
      8. I felt confident in the pharmacist’s ability to administer the injectable medication.12345
      9. The pharmacist was knowledgeable about the service provided.12345
      10. I felt rushed during the appointment.12345
      11. If a friend were in need of similar help, I would recommend this service to him or her.12345
      Section 2 (Optional)
      Please consider the service you received today and complete the sentences below.
      • 1.
        I enjoy this service because _________________________________________________________________________________________
      • _____________________________________________________
      • 2.
        This service could be better if ____________________________________________________________________________
      • _____________________________________________________
      Section 3
      Please consider the service you received today. Have you received this type of service in a different setting, such as a mental health clinic or a doctor’s office?
      Please circle YES or NO
      If YES, please answer the questions in Section 3 before proceeding to Section 4 by circling one number on each line.
      If NO, skip this section and continue to Section 4.
      Tabled 1
      Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
      1. I trusted the pharmacist as much or more than the person who provided this service elsewhere.12345
      2. The pharmacist did not communicate the process as clearly as the person who provided this service elsewhere.12345
      3. The pharmacist was as knowledgeable or more about the service provided than the person who provided this service elsewhere.12345
      4. The pharmacist did not listen as carefully to what I have to say as the person who provided this service elsewhere.12345
      5. This service was more convenient than a similar service received elsewhere.12345
      Section 4
      Please circle one answer on each line in the section below regarding your demographic characteristics.
      Tabled 1
      State of residenceAZCAHIIDORCOTXVAWAOther
      Age group18-2020-3940-6465+
      GenderFemaleMale
      Number of years with current conditionLess than 1 year1-5 years6-10 years10 years or more
      Number of months using this serviceLess than 1 month1-6 months7-12 months13-18 months19-24 monthsMore than 24 months

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      Biography

      Emanuela V. Mooney, PharmD, PGY1 Community Pharmacy Resident, Albertsons Companies, Centennial, CO
      Jeffrey G. Hamper, PharmD, Manager, Academic Relations, Albertsons Companies, Boise, ID
      Robert T. Willis, PharmD, Residency Program Director and Corporate Pharmacy Trainer, Albertsons Companies, Centennial, CO
      Tonna L. Farinha, PharmD, Pharmacy Residency Program Coordinator and Experiential Coordinator, Albertsons Companies, Centennial, CO
      Charlotte A. Ricchetti, PharmD, Associate Professor, Department of Pharmacy Practice and Director of Pharmacy Residency Programs, Regis University, Denver, CO