¹Johnson & johnson, Global Epidemiology, Taipei, Taiwan, ²Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Office of Planning, Kaohsiung, Taiwan, ³Johnson & Johnson, Global Epidemiology, Taipei, Taiwan, ⁴Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Department of Addiction Medicine, Kaohsiung, Taiwan, ⁵Johnson & Johnson, Medical Affairs, Taipei, Taiwan, ⁶Johnson & johnson, Global Epidemiology, New Jersey, United States, ⁷Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Department of Geriatric Psychiatry, Kaohsiung, Taiwan, ⁸Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Department of Pharmacy, Kaohsiung, Taiwan, ⁹Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Office of the Director, Kaohsiung, Taiwan

Background: Second-generation long-acting injectable antipsychotics (SGA-LAIs) offer safer alternatives compared to first-generation LAIs (FGA-LAIs) but have seen low utilization in Taiwan due to budget limits. In January 2022, Taiwan's National Health Insurance introduced a dedicated budget policy for LAIs (LAI-DBP) with an annual allocation of NT$2.7 billion to address this. Our prior study demonstrated that the LAI-DBP significantly increased overall LAI and SGA-LAI utilization among patients with schizophrenia (SCZ) or schizoaffective disorder (SCA). This study further examines the policy's impact on post-discharge LAI prescribing decisions.

Aims & Objectives: To describe and assess the impact of the LAI-DBP and other factors on post-discharge LAI prescribing decisions in patients with SCZ or SCA.

Method: This retrospective study analyzed electronic medical records from Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, including adult patients discharged with a primary diagnosis of SCZ or SCA between October 2010 and September 2024. LAI prescribing decisions were evaluated by the proportion of prescriptions categorized as first-generation LAIs (FGA-LAI) only, second-generation LAIs (SGA-LAI) only, or both (FGA/SGA-LAI) among patients receiving antipsychotics within 40 days post-discharge. Logistic and polytomous logistic regression assessed associations between LAI prescribing and factors such as LAI-DBP, first SGA-LAI reimbursement (R-SGA-LAI), demographics, and clinical history.

Results: A total of 10,294 discharge records from 2,492 patients were identified. The overall proportion of post-discharge LAI prescriptions among antipsychotic users remained steady increase over time (annual increase 1.03 fold, (19.1% in 2010 and 26.9% in 2024). However, FGA-LAI-only use declined sharply following the introduction of LAI-DBP, dropping to 1.0% by 2024. SGA-LAI-only prescriptions rose from 0% in 2010 to 11.4% in 2021; it accelerated and reached 25.3% by 2024 following LAI-DBP. Combined FGA/SGA-LAI use remained low and stable (range 0.0%-1.7%). Logistic regression confirmed a significant increase in SGA-LAI-only prescriptions after LAI-DBP (P=0.0368) and a significant decrease in FGA-LAI-only prescriptions over time (P < 0.0001). Living alone and family interaction problems were linked to higher odds of receiving any LAI. Discharge referrals to return home, community support, or an institution (versus another hospital) also increased LAI use. Clinical factors increasing LAI prescribing included emergency or involuntary hospitalization, history of aggression, more prior emergency department and outpatient visits at our hospital, and prior sedative‑hypnotic or anticholinergic use. Factors associated with lower LAI use included placement or housing difficulties, length of stay >30 days, more prior inpatient admissions, ≥2 medical comorbidities, depressive symptoms at discharge, and severe financial hardship. FGA‑LAI prescribing correlated positively with patient‑requested discharge, poor illness adaptation, substance/alcohol misuse, recent violence, and impulsivity, and negatively with inpatient depressive symptoms and caregiver burden issues. SGA‑LAI use was more likely in males, those with suicidal ideation, prior mood‑stabilizer use, or discharge for employment, and less likely after prior antidepressant use or reporting to the suicide‑prevention center.

Discussion & Conclusions: Following LAI‑DBP, SGA‑LAI use rose markedly while FGA‑LAI use declined, with overall post‑discharge LAI use reached 26.9% by 2024. Prescribing decisions were shaped by policy plus patient demographics, clinical risk, and social factors.