Increased access to healthcare providers, including pharmacists, can help alleviate the shortage of available care to residents during the COVID-19 pandemic. The pandemic has had many unfortunate consequences, one of the most notable being the avoidance of physician visits for both chronic and acute care. Access to healthcare has been compromised while we have seen the closing or reduced hours of many small primary care practices and decreased reimbursement for telemedicine visits vs. in-person visits.1
Anxiety or depression during a pandemic
Mental health symptoms have increased during the COVID-19 pandemic. Average biweekly data for October 2020 found that 37.7% of adults in the U.S. reported anxiety and/or depressive disorder symptoms, up from 11.0% in 2019.
The need for mental health and substance-use care is expected to increase due to the COVID-19 pandemic, which may exacerbate mental health conditions and barriers to accessing care experienced by those already in need of these services. It leaves many people in need of mental health and substance use treatment.3/4
- On average, more than one in three adults in the U.S. has reported symptoms of anxiety and/or depressive disorder since May 2020. In comparison, from January to June 2019, approximately one in ten adults reported symptoms of anxiety and/or depressive disorder.
- As shown in the figure below, average biweekly data for October 2020 found that 34.6% of adults in Idaho reported symptoms of anxiety and/or depressive disorder, compared to 37.7% of adults in the U.S.
Schizophrenia propensity for relapse during a pandemic
Schizophrenia is a debilitating chronic disease that requires lifelong medical care and supervision. Even with treatment, most residents relapse within five years, and suicide may occur in up to 10% of residents. Poor adherence to oral antipsychotics is the most common cause of relapse.
The discontinuation rate for oral antipsychotics in schizophrenia ranges from 26% to 44%. As many as two-thirds of residents are at least partially non-adherent, resulting in an increased risk of hospitalization. A helpful approach to improve adherence in schizophrenia is the use of long-acting injectable (LAI) antipsychotics, although only a minority of residents receive these.
Research shows significant improvements in adherence with LAIs compared with oral drugs, accompanied by lower rates of discontinuation, relapse, and hospitalization. A need exists to encourage broader LAI use, especially among residents with a history of nonadherence with oral antipsychotics and specifically during periods of decreased access to in-person oral administration, such as the Covid-19 pandemic.
Residents who preferred LAI antipsychotics prioritized self-empowerment and quality-of-life-related goals. When given the option, residents preferred less-frequent, quarterly injections over monthly injections and daily oral medications, according to a recent resident-reported medication preference questionnaire conducted in February, 2020.2
Understanding residents’ preferences for long-acting injectable (LAI) or oral antipsychotics (pills) could help reduce potential barriers to LAI use in schizophrenia.
But despite its proven effectiveness, LAIs are still underused for different reasons, including economic (high cost), mistrust, fear, stigma, and outdated concepts. On the part of the residents, the refusal is related to the mode of administration (injection); the control of the treatment (the feeling that they no longer decide); and the administration protocols (in specialized centers; post-injection monitoring in the case of olanzapine pamoate, etc.)
To all these, new limitations of prescription and administration caused by the COVID-19 pandemic now exist.
Treatment access through pharmacist administered care
Heartland Pharmacy understands the numerous effects that a pandemic has on the continued quality care of residents, and we have particularly noted the lack of accessibility to effective mental health treatments. We are dedicated to making a difference in the lives of individuals, families, and healthcare partners. Our mission to deliver solution-driven services and the barriers of mental health treatment faced during this unique time has driven us to create a new, vital service to our community.
We now offer mental health injections to the Boise area. Physicians and psychiatrists can contact the pharmacy to coordinate prescription delivery for residents via our website or phone number. The resident will be provided appointment information and receive treatment in a safe, sanitary environment.
- HealthLandscape. vCoronavirus Pandemic-Related Potential Family Medicine Office Closures and Economic Impact. https://healthlandscape.org/covid19/. Accessed November 25, 2020.