From QAAPAPLE 1 to QAAPAPLE 2: How do we move from one algorithm to another one with Long acting antipsychotics (LAIs).

BACKGROUND In 2011, the authors published an algorithm summarizing practice guidelines related to the use of long-acting antipsychotics (LAIs) called the Quebec Algorithme Antipsychotique a Action Prolongee (QAAPAPLE), and proposed that it be revised every 5-10 years to update it according to most recent scientific knowledge. Therefore, a re-evaluation of the algorithm was conducted to determine which recommendations were still relevant and which needed modification. METHODS The authors conducted a twofold approach: a review of literature to include new evidence since 2011 (controlled trials, meta-analyses and practice guidelines); and a participatory component involving electronic surveys, participatory conferences, clinical speakers and expert patients. RESULTS Overall, prescribers tended to make decisions based on personal experience and conversations with colleagues rather than evidence-based guidelines. To test if the algorithm was useful worldwide, it was presented in the United Arab Emirates, where the feedback was in agreement with the algorithm and its limitations. CONCLUSIONS Since its initial publication, the QAAPAPLE algorithm has been updated to guide clinicians on the use of LAIs. The new algorithm has also been assessed outside Canada to test its generalisability worldwide, and indicated its flexibility, efficiency and user-friendliness in order to guide clinicians on the use of LAIs.