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<p style="text-align: right; margin: 10px 0 5px; font-size: 10em;">See letter by <a href="/JCP/article/Pages/2017/v78n08/16lr11402.aspx" target="_top">Stip</a>, reply by <a href="/JCP/article/Pages/2017/v78n08/16lr11402a.aspx" target="_top">Correll et al</a>, and article by <a href="/JCP/article/Pages/2016/v77s03/v77s0301.aspx" target="_top">Correll et al</a>
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<p class="ltrs-br-ltr-br-title"><span class="bold">Physician Characteristics Associated With Prescription of Long-Acting Injectable Antipsychotics</span></p>
<p class="ltrs-br-ltr-br-body-text"><span class="semibold">To the Editor:</span> In a comprehensive and elegant review on long-acting injectable antipsychotics (LAIs) published in a recent supplement to the <span class="italic">Journal</span>, Correll et al reported that “education about the potential benefits of LAIs should be provided to clinicians and the health care team.”<span class="htm-cite"><a href="#ref1">1</a></span><span class="superscript">(p17)</span> My colleagues and I agree with the authors that LAIs have been shown to reduce relapse compared to oral antipsychotics, but their prescribing patterns are not well known. </p>
<p class="ltrs-br-ltr-br-body-text">A recent study conducted in Canada by my colleagues and I investigated prescribing determinants of LAIs among physicians treating schizophrenia using the Quebec drug plan (Régie de l’assurance maladie du Québec [RAMQ]) database. The RAMQ database also includes information on the insured person, such as age, gender, and region, and information on the physicians, such as the period of graduation. Patients with schizophrenia who were incident users of an LAI between January 2008 and March 2012 were selected. Schizophrenia diagnoses were considered confirmed if the last diagnosis related to psychiatric diseases (<span class="italic">ICD-9</span> codes 290.0–311.9) recorded in the database was one of schizophrenia (<span class="italic">ICD-9</span> code 295.x). </p>
<p class="ltrs-br-ltr-br-body-text">In this study, 8,230 patients received at least 1 prescription for an LAI. Of these patients, 4,974 did not receive a prescription for an LAI in the year preceding index date (incident users). A total o<a id="_idTextAnchor000"></a>f 3,957 of them were covered by the RAMQ drug insurance for at least 1 year before and 1 year after index date. Finally, 1,996 patients were selected as patients with schizophrenia using an LAI. The general population consisted of a random sample of patients (N<span class="thinspace"> </span>=<span class="thinspace"> </span>117,621) enrolled in the RAMQ database. Physician characteristics related to the prescription of the first LAI in the schizophrenia population and prescribing in the general population were compared using the χ<span class="superscript">2</span> test and with a base index of 100, where ><span class="thinspace"> </span>100 indicates an overrepresentation and <<span class="thinspace"> </span>100 indicates an underrepresentation in users with schizophrenia. </p>
<p class="ltrs-br-ltr-br-body-text">Prescribers of LAIs for schizophrenia were more likely to graduate in 1990–1999 (index<span class="thinspace"> </span>=<span class="thinspace"> </span>153, <span class="italic">P</span><span class="thinspace"> </span>><span class="thinspace"> </span>.001) compared to 1970–1979 (index<span class="thinspace"> </span>=<span class="thinspace"> </span>63, <span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.001), more likely to practice in Montréal-Centre than in other areas of Quebec<span class="semibold"> </span>(index<span class="thinspace"> </span>=<span class="thinspace"> </span>147, <span class="italic">P</span><span class="thinspace"> </span>><span class="thinspace"> </span>.001), and more likely to work in both inpatient and outpatient settings (index<span class="thinspace"> </span>=<span class="thinspace"> </span>338 and index<span class="thinspace"> </span>=<span class="thinspace"> </span>391, respectively, <span class="italic">P</span><span class="thinspace"> </span>><span class="thinspace"> </span>.001) compared to prescribers for the general population. Data also showed that the use of atypical LAIs compared to typical LAIs was significantly higher (<span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.001) among younger prescribers (graduation<span class="thinspace"> </span>=<span class="thinspace"> </span>1990), in contrast with a significantly higher (<span class="italic">P</span><span class="thinspace"> </span><<span class="thinspace"> </span>.001) use of typical LAIs among older prescribers (graduation<span class="thinspace"> </span>=<span class="thinspace"> </span>1979). The degree of prescribing LAIs appeared to be heterogeneous across the province of Quebec. </p>
<p class="ltrs-br-ltr-br-body-text">In summary, LAI use was more common among recently graduated physicians and those in urban areas and working in both inpatient and outpatient settings.</p>
<p class="references_references-heading"><span class="smallcaps">Reference</span></p>
<p class="references-references-text-1-9"><a name="ref1"></a><span class="htm-ref"> 1.	</span>Correll CU, Citrome L, Haddad PM, et al. The use of long-acting injectable antipsychotics in schizophrenia: evaluating the evidence. <span class="italic">J Clin Psychiatry</span>. 2016;77(suppl 3):1–24. <a href="
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=27732772&dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="
http://dx.doi.org/10.4088/JCP.15032su1"><span class="pubmed-crossref">doi:10.4088/JCP.15032su1</span></a></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Emmanuel Stip, MD, MSc</span><span class="superscript">a</span></p>
<p class="ltrs-br-ltr-br-author"><a href="mailto;
emmanuel.stip@umontreal.ca">
emmanuel.stip@umontreal.ca</a></p>
<p class="end-matter"><span class="superscript">a</span>Department of Psychiatry, Centre Hospitalier de l’Université de Montréal; and Department of Psychiatry, Hôpital Notre-Dame–Pavillon L. C. Simard, Montreal, Quebec, Canada </p>
<p class="end-matter"><span class="bold-italic">Potential conflicts of interest: </span>None.</p>
<p class="end-matter"><span class="bold-italic">Funding/support: </span>RAMQ data were obtained with funding from Lundbeck and Otsuka Canada.</p>
<p class="end-matter"><span class="italic">J Clin Psychiatry 2017;78(8):e1060</span></p>
<p class="doi-line"><span class="italic">
https://doi.org/</span><span class="doi">10.4088/JCP.16lr11401</span></p>
<p class="end-matter"><span class="italic">© Copyright 2017 Physicians Postgraduate Press, Inc.</span></p>
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