Alberto Augsten, PharmD, Interprets National Provider Survey on Schizophrenia, BD

In an interview with HCPLive, psychopharmacologist and toxicologist Alberto Augsten, PharmD, an adjunct professor at Nova Southeastern University, shared insights into a recent national survey reporting healthcare providers' experiences treating patients with schizophrenia or bipolar I disorder.

Drawing from his expertise and recent survey findings, Augsten discusses strategies for treatment selection, the benefits of long-acting injectables, and the importance of patient-centered care. He also addresses the barriers clinicians face when adopting new therapies and highlights non-pharmacological interventions that support recovery.

He provided a deep dive into the reported statistics, such as 80% of providers citing intolerable adverse events as a reason for medical switching, 97% reporting looking for treatment options that minimize the number of medications needed, among several others.

HCPLive: Given your expertise in psychopharmacology, what top factors influence medication adherence in patients with schizophrenia or bipolar disorder?

Augsten: Adherence is always one of the front-running questions people have. The population, for the most part, is typically suffering through poor insight. They're struggling with medications that increase the risk of having side effects. Ideally, it's really trying to ensure that the education is there, trying to find modalities that make it easier for them to utilize these products, like long-acting injectable antipsychotics, and really ensuring that they have access.

HCPLive: Given the negative impact of frequent medication switching, how do you decide when to switch treatments?

Augsten: Switching is a very difficult concept. Typically, we try to limit switches as much as possible to ensure continuity of care. In the event that [an] individual is suffering from significant side effects…we try to find regimens that are easier for them to handle.

HCPLive: How do long-acting injectables influence treatment consistency and reduce potential concerns related to non-adherence?

Augsten: Non-adherence in this population has been quoted to be as high as 50% in some studies, or] close to 70%.

The best treatment for individuals with schizophrenia and or bipolar disorder is to ensure that they have medication in your body. One of the clear ways to do that is to ensure that they're on the long-acting injectable antipsychotic.

HCPLive: The survey highlighted that quality of life is just as important as symptom control. How should clinicians balance these two factors while considering treatments?

Augsten: A lot of studies focus on efficacy in general, which is a high focus on symptom control. What we find…is quality of life is a very important factor. Some of the things that we do is to ensure that when we're focusing on a regimen has to be a combination of symptom control and the quality-of-life metrics.

HCPLive: What factors contribute to the disparity in the quality of life between patients with schizophrenia (21%) and bipolar I disorder (66%)?

Augsten: Probably the biggest factor is cognitive burden… this population is impacted by the disease itself, and the disease unfortunately affects their prefrontal cortex and ability for them to reason and have [a] higher level of functioning. A high focus on cognitive burden would be very beneficial in this patient population.

HCPLive: What are the most common adverse events that lead to treatment changes?

Augsten: I would say probably in the top of the list are waking. Absolutely sexual dysfunction…In the anti-psychotic world, metabolic side effects [are] a front-runner, meaning anybody [who] has any effects with weight gain, or even in their glucose profile or lipid profile, [has] a high risk of discontinuing the medications to combat that. There are various medications that we can use that reduce that risk, and there's some new modalities that do so, and that should be one of the main concerns when treating this patient.

HCPLive: How realistic is the goal of minimizing the number of medications?

Augsten: The bottom line, it doesn't matter what we're dealing with. It's across the board; pill burden is an issue with all patients… [and] a major cause of [non]-adherence…. that’s a major concern. Adherence is a front-runner issue for re-hospitalization and complications down the line.

One of the ways that we attack that is by initiating long-acting injectable antipsychotics. We have medications that are injectable [for] 1 month, some of them last 2 months. We have some now that are lasting as long as 6 months.

HCPLive: Less than a third of providers (31%) incorporate new treatments as quickly as possible, while most prefer to wait for more data. What should clinicians consider when assessing new medication?

Augsten: This has been studied across the board, and for the for the most part, most providers are looking for efficacy…does it actually work? Why would a provider initiate a regimen that's not efficacious in nature, regardless of what other benefits it may have?

Second to that, of course, would be the safety profile. We would love to have something that's efficacious and minimizes the side effects.

HCPLive: What additional data would strengthen the confidence in newer treatments?

Augsten: Probably more head-to-head studies…that are looking at quality of life.

HCPLive: What objective measures should clinicians prioritize?

Augsten: That's something that traditionally is tracked in a few modalities. Traditionally, we look at hospitalization rates, specifically 30-day readmission rates after they get discharged from [an] acute care setting.

We also look at adherence. Are they actually picking up their medications from the pharmacy, or, in this case, coming to the clinic to get their long-acting injectable anti-psychotic?

Something that we're doing a little bit more recently: quality of life. We're looking at real-life functioning…Do they have employment? Do they have a social life? Do they have a significant other…do they even have an active driver's license? These are quality metrics. That is what impacts the patient's lives.

HCPLive: What non-medication interventions make the biggest difference?

Augsten: Off the bat, what we've seen time and time again…patients that have access to a strong family support network have remarkable results, and then those that don't having the structure in place to link them with peers. Also, you can do things like cognitive behavior therapy, access to employment, education, so all these things focus on the quality-of-life metrics.

HCPLive: Is there anything else you would like to highlight?

Augsten: To me, the biggest [finding that] stands out is the reluctance to take on new treatment modalities...because really, they're missing out on some great regimens that are coming to market, and their patients are going to have a significant positive response.