Optimizing Care Transitions and Access in Schizophrenia Management

This episode, titled "Optimizing Care Transitions and Access in Schizophrenia Management," features panelists Mark Jankelow, Dr. John Kane, and Dr. Hara Oyedeji addressing three interconnected dimensions of schizophrenia care delivery: telemedicine, inpatient-to-outpatient treatment planning, and medication access.

Mark Jankelow opens by reflecting on telemedicine's role in psychiatric care, crediting the COVID-19 pandemic with accelerating its adoption. He describes his practice's proactive approach — including comprehensive intake paperwork that designates backup contacts for patients who struggle to connect — while acknowledging real limitations, such as the difficulty of conducting initial assessments or developing safety plans remotely. He affirms that in-person evaluation remains preferable when possible, particularly for new patients, but endorses telemedicine as a valuable and necessary tool in modern psychiatric practice.

Dr. John Kane then addresses the question of initiating long-acting injectable medications during inpatient stays, advocating strongly for building this transition into the treatment plan from the outset. He describes an ideal inpatient pathway in which oral medication is introduced first to establish tolerability and initial response, with the explicit expectation communicated to patients and families that a long-acting formulation will follow. He argues that framing this transition as a planned and anticipated step — rather than a later surprise — makes it significantly easier for outpatient clinicians to follow through. He also reiterates his view that long-acting injectables may have an underexplored role even earlier in the care continuum, including in emergency department settings.

Dr. Oyedeji closes the episode by addressing the critical but often overlooked issue of medication access during care transitions. She champions drug sampling as an effective bridging strategy and encourages clinicians to cultivate relationships with pharmaceutical representatives as a legitimate and practical resource for patient assistance programs, cost-reducing coupons, and case-specific guidance. She identifies prior authorization as a key barrier that deters many clinicians from initiating newer treatments, and calls for education beginning in clinical training to help providers approach the administrative process with confidence rather than avoidance — emphasizing that mastering these systems is ultimately what gets medications into patients' hands.

In the next episode, "Leveraging Novel Delivery Systems to Optimize Inpatient to Community Transitions in Schizophrenia," panelists will examine how emerging pharmacological delivery approaches — from sublingual and intranasal agents to subcutaneous long-acting injectables — can bridge the critical gap between inpatient stabilization and community-based care, reducing relapse risk and the costly cycle of rehospitalization.