Document Type
Article
Publication Date
12-16-2025
Abstract
Background: Long-acting injectable (LAI) antipsychotics improve adherence and reduce schizophrenia relapse rates vs oral antipsychotics (OAs) but remain underused. The ADVANCE study explored country-level differences in LAI use among healthcare professionals (HCPs), patients, and caregivers, to identify drivers of LAI use. Study Design: ADVANCE included participants from Australia, Canada, China, Germany, Israel, South Korea, Spain, and the United States. Eligible HCPs spent ≥25% of their time in direct patient care, managed an adult population of whom ≥10% have schizophrenia, and treated patients prescribed LAIs. Patients aged ≥18 years and caregivers of adults living with schizophrenia who had tried/been offered an LAI were included. Participants completed a 30-minute survey. Study Results Systemic factors reported by HCPs (n=791) associated with higher LAI use included being a physician vs nonphysician, having Hispanic/Latino/Spanish ethnicity, managing more adult patients with schizophrenia, and having more staff and nurse support. Nonadherence to OAs was the main HCP-reported reason for LAI recommendation. Patient characteristics, lack of available LAIs corresponding to OAs, and perceptions of patients’ behavior were top reasons HCPs would not recommend an LAI. For patients (n=470), symptom improvement and HCP recommendation, and for caregivers (n=381), ease of injections, reduced hospitalizations, and fewer side effects were the main reasons for LAI acceptance. The top reason patients and caregivers declined LAIs was concern about side effects. Conclusions: Results from ADVANCE demonstrate that systemic and attitudinal factors influence LAI use by HCPs, and these factors vary by country. Enhancing HCP-patient communication may improve LAI acceptance.
Keywords
adherence, barriers, caregiver, psychiatrist, relapse prevention, side effects
Language
English
Publication Title
Schizophrenia Bulletin Open
Rights
©2025 The Author(s). This is an open access work distributed under the terms of the Creative Commons Attribution-Non-Commercial (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Recommended Citation
Kelli R Franzenburg, Rolf Hansen, Mark Suett, Ayelet Yaari, Aviva Peyser Levin, Martin Sergerie, Sigal Kaplan, Kameron Sedigh, Stephan Heres, Martha Sajatovic, Attitudes Driving Regional Differences in Long-Acting Injectable Antipsychotic Utilization for Schizophrenia among Healthcare Professionals, Patients, and Caregivers (ADVANCE): Results from a Multinational Survey Study, Schizophrenia Bulletin Open, Volume 7, Issue 1, 2026, sgaf032, https://doi.org/10.1093/schizbullopen/sgaf032
Manuscript Version
Final Publisher Version