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Addressing clozapine under-prescribing and barriers to initiation

a psychiatrist, advanced practice provider, and trainee survey

Leung, Jonathan G.a; Cusimano, Josephb; Gannon, Jessica M.c; Milgrom, Olgac; Valcourt, Stephanie C.d; Stoklosa, Joseph B.d; Kemp, Michaele; Olsufka, Williamf,,g; Vickery, P. Brittanyh; Nichols, Stephanie D.i; Crouse, Ericka L.j; Paxos, Chrisk; Johnson, Emily K.l; Palmer, Brian A.l

International Clinical Psychopharmacology: May 17, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/YIC.0000000000000269
Original article: PDF Only

Clozapine use has declined, despite its superior antipsychotic efficacy in treatment-resistant schizophrenia. Implications for clozapine underutilization include suboptimal treatment outcomes and increased hospitalizations. Many barriers preventing the use of clozapine have been described in the literature, including suboptimal knowledge and poor perceptions. The aim of this study was to assess psychiatry prescribers’ perception and knowledge of clozapine. A survey was distributed to advanced practice providers, psychiatrists, and trainees (i.e. residents and fellows) at 10 medical centers within the US and Canada. The survey asked respondents about their perception of clozapine use and assessed their pharmacotherapeutic knowledge of clozapine. Two hundred eleven individual submitted completed surveys of a possible 1152; a response rate of 18.3%. There were no statistically significant differences between the advanced practice provider plus psychiatrist groups and the trainee group for most perception (eight of nine) and knowledge (eight of nine) questions. The knowledge questions with the lowest scores pertained to clozapine reinitiation and myocarditis. The majority of all respondents (144, 68.2%) felt that clozapine prescribing was a burden. Findings of this study support the need for continued clozapine education regardless of a prescriber’s age/experience. Future studies to assess barriers to clozapine prescribing should extend beyond academic centers.

aDepartment of Pharmacy, Mayo Clinic, Rochester, Minnesota

bDepartment of Pharmacy, Michigan Medicine, Ann Arbor, Michigan

cWestern Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

dSchizophrenia and Bipolar Disorders Unit, McLean Hospital, Harvard Medical School, Belmont, Massachusetts

eVitalité Health Network, Dr. George-L.-Dumont University Hospital Center, Moncton, Canada

fMount Sinai Beth Israel, New York, New York

gTouro College of Pharmacy New York, New York

hHendersonville Health Sciences Center, Wingate University School of Pharmacy, Hendersonville, North Carolina

iSchool of Pharmacy, Husson University, Bangor, Maine

jDepartment of Pharmacotherapy and Outcomes Science, VCU School of Pharmacy, Richmond, Virginia

kDepartment of Pharmacy Practice, Northeast Ohio Medical University, Rootstown, Ohio

lDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA

Received 7 December 2018 Accepted 30 April 2019

Correspondence to Jonathan G. Leung, PharmD, Psychiatric Clinical Pharmacist, Department of Pharmacy, Mayo Clinic, Rochester, MN 55902, USA, Tel: +507 255 5555; fax: +507 255 7556; e-mail:

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