Developing a Sustainable Long-Acting Injectable Clinic in an Academic Psychiatric Hospital: A Clinical Implementation Model
Elischa Jamal Sanders, MD, PhD,Massachusetts General Hospital/McLean Psychiatry Residency Program, Boston, MA, Harvard Medical School, Boston, MA
Tucker Avra, MD, DVM: Massachusetts General Hospital/McLean Psychiatry Residency Program, Boston, MA, Harvard Medical School, Boston, MA
Cheryl Yunn Shee Foo, PhD: Harvard Medical School, Boston, MA, Massachusetts General Hospital, Boston, MA
Background: Long-acting injectable (LAI) medications can improve medication adherence and reduce relapse and hospitalization risk for individuals with serious mental illness (SMI). However, access to LAIs is often limited by systems-level barriers, including fragmented workflows for medication procurement, insurance authorization, storage, administration, and patient follow-up. Consequently, many patients who may benefit from LAIs are unable to initiate or maintain treatment, including after a psychiatric hospitalization. A sustainable LAI clinic therefore requires an integrated clinical and operational model.
Methods: We systematically identified implementation needs and core components of an LAI clinic through a stakeholder-engaged process. The Massachusetts General Hospital (MGH) Wang outpatient injection clinic was used as a reference model and adapted for an academic psychiatric hospital providing inpatient and outpatient care of people with SMI who currently rely on external referral pathways for LAI administration. Psychiatry leadership, residents, and pharmacy services assessed feasibility, identified required resources, and mapped integration with existing clinical workflows.
Results: Stakeholders identified six essential components, including: 1) reliable medication procurement and onsite storage systems, 2) streamlined processes for insurance/benefits and financial assistance navigation; 3) billing and reimbursement processes; 4) clearly defined pharmacy and clinical responsibilities, 4) dedicated staffing and physical space; and 5) coordinated patient-provider follow-up for medication continuation and monitoring. A resident-supported staffing model was identified as a potential capacity building strategy that could simultaneously provide structured training in LAI prescribing, shared decision-making, and team-based psychiatric care. The proposed model specifies six key steps, with an accountable role assigned at each: 1) patient referral and intake, 2) shared decision-making, 3) insurance authorization and financial assistance navigation, 4) medication procurement/delivery, 5) LAI administration, and 6) longitudinal follow-up and monitoring.
Conclusion: A structured implementation model may facilitate translation from clinical interest to sustainable practice and provide a replicable model for academic psychiatric settings seeking to improve access to LAI treatment.