M115. Improving Clozapine Use in the United States: A Survey of Barriers and Solutions Informing a Workgroup to Devise a National Strategy

摘要

>Background: Despite its proven efficacy for the treatment of psychosis, clozapine remains underutilized due to many barriers associated with its use. To date no large scale efforts have been undertaken to tackle and improve these barriers. >Methods: Two anonymous surveys were distributed to Maryland prescribers to identify and rank the importance of potential barriers to clozapine use (first survey) and possible solutions (second survey sent only to current clozapine prescribers). Subsequently, a work group assembled by the National Association of State Mental Health Program Directors (NASMHPD) of researchers and clinicians, funded by SAMHSA, used the survey findings to generate recommendations on how to address major barriers and implement desired solutions. >Results: Thirty-two percent of prescribers (n = 255/860) responded to the first survey. Closer monitoring, regular blood work, and potential for non adherence to blood work (highest overall) were reported as the greatest clinical barriers while lack of a centralized system (prior to ClozapineREMS), time spent on administration tasks, and lack of administration structure were the most significant nonclinical barriers. The most significant side effect barriers were cardiomyopathy, metabolic syndrome and agranulocytosis. Prescribers who did not use clozapine also ranked “not feeling competent” and “limited experience in residency training.” The solutions survey (22.3%; n = 21/94) found that current clozapine prescribers ranked point of care fingerstick, Benign Ethnic Neutropenia support, education for families, centralized clinic, and physician education program as the most helpful solutions. As for the workgoup, 35 recommendations were developed and the White Paper was accessible following national feedback. >Conclusion: Our work proffers new national recommendations to help varied systems of care address barriers to the use of clozapine. Improved access to clozapine could benefit millions of patients and, in turn, could result in substantial cost savings to the entire health care system.