Rutgers study finds patients with schizophrenia are less likely to be rehospitalized when given antipsychotic injections

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Long-acting injectable medications for schizophrenia can decrease the likelihood of patient rehospitalizations, according to a new Rutgers University Health study.

In their findings, published in the Journal of Clinical Psychopharmacology, researchers concluded that compared to oral antipsychotics, injections accounted for a 75% reduction of hospital readmissions.

Rutgers Health analyzed data pulled from hospital systems where patients were discharged with schizophrenia or schizoaffective-related disorders from August 2019 to June 2022.

Of total discharged patients, 240 individuals were given oral medications while 103 opted for long-acting injections.

The results showed that patients given antipsychotics in pill form had a hospital readmission rate of 8.3% over a 30-day period. Meanwhile, of patients that were administered drugs by injection, less than 2% returned to the hospital within a month.

These conclusions strengthen the belief that injections are more beneficial for individuals with schizophrenia than oral medications, said Rutgers University psychiatric clinical pharmacist Daniel Greer, the lead author of the study.

“One of the biggest problems with patients who have schizophrenia or schizoaffective disorder, is a lot of the symptoms can cause impairment in functioning, and mental functioning,” he said. “So remembering to take medication every day when you’re having hallucinations or delusions or disorganized thinking can be quite hard.”

Although oral antipsychotics are more readily available for schizophrenia patients at hospital discharge, injections benefit by slowly releasing the treatment over time, said Greer.

“Some of them are relatively quick acting. For example, one of them is every two weeks, you get the shot. But the majority that we use are every month or every two months,” Greer said. “There’s also formulations that’s once every three months, and there’s one that’s once every six months. So this is a lot easier for the patients because they don’t have to remember to do something every day, and it keeps that drug level in their system really stable.”

But Greer, who also practices at Saint Joseph’s University Medical Center in Paterson, New Jersey, said there are significant financial obstacles.

“Long-acting injectable medications can be more expensive than the oral medications,” he said.

Historically, some health insurers have favored oral treatments because antipsychotic injections cost more to cover. But antipsychotics end up causing higher medical costs in the long run, and hospitals are subject to penalties for high readmission rates over time.

“Hospitals get less reimbursement for patients who are readmitted within 30 days,” Greer said. “So there are financial implications if you’re having a lot of quick readmissions for the same reason that you just discharge patients on.”

Some drug companies offer free trial programs for hospitals to get the medications, including injections formulated from pills. But not all commonly used medications are available as injections.

“There are some challenges,” said Greer. “ So if the patient’s really stable on an oral, sometimes the long-acting injections aren’t even an option.”

Another challenge is a higher preference from schizophrenia patients to opt for oral medications over injections, said Gree.

“A lot of patients don’t want that,” he said. “They’re afraid of needles. They don’t want something that lasts in their system for a long time because they worry about maybe having a side effect that lasts that whole time.”

But Greer emphasizes that all of these medications have been carefully tested before being approved.