Prescription and Underprescription of Clozapine in Dutch Ambulatory Care
Purpose: To our knowledge, no study has examined in a structured way the extent of underprescription of clozapine in ambulatory patients with Non-Affective Psychotic Disorder (NAPD). In the Netherlands, psychiatric care for such patients is provided by Flexible Assertive Community Treatment (FACT) t...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-06-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fpsyt.2018.00231/full |
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| author | Yvonne C. van der Zalm Yvonne C. van der Zalm Fabian Termorshuizen Peter F. Schulte Peter F. Schulte Jan P. Bogers Jan P. Bogers Machteld Marcelis Machteld Marcelis Iris E. Sommer Jean Paul Selten Jean Paul Selten |
| author_facet | Yvonne C. van der Zalm Yvonne C. van der Zalm Fabian Termorshuizen Peter F. Schulte Peter F. Schulte Jan P. Bogers Jan P. Bogers Machteld Marcelis Machteld Marcelis Iris E. Sommer Jean Paul Selten Jean Paul Selten |
| author_sort | Yvonne C. van der Zalm |
| collection | DOAJ |
| description | Purpose: To our knowledge, no study has examined in a structured way the extent of underprescription of clozapine in ambulatory patients with Non-Affective Psychotic Disorder (NAPD). In the Netherlands, psychiatric care for such patients is provided by Flexible Assertive Community Treatment (FACT) teams and by early intervention teams. In 20 FACT teams and 3 early intervention teams we assessed the proportion of patients who: use clozapine (type 1 patients), previously used this drug (type 2), have an unfulfilled indication for this drug, by type of indication (type 3), or were at least markedly psychotic, but had not yet received two adequate treatments with other antipsychotic drugs (type 4). We expected to find major differences between teams. To rule out that these differences are caused by differences in severity of psychopathology, we also calculated the proportions of patients who use clozapine given an indication at any time (number of type 1 patients divided by the sum of type 1, 2, and 3 patients).Materials and methods: The nurse practitioner of each team identified the patients already on clozapine. Next, using a highly-structured decision tree, the nurse practitioner and psychiatrist assessed whether the remaining patients had an indication for this drug. Indications were treatment-resistant positive symptoms, tardive dyskinesia, aggression and suicidality. The severity of positive symptoms was determined using the Clinical Global Impression-Schizophrenia Scale (CGI-SCH).Results: In the participating FACT-teams 2,286 NAPD patients were assessed. The range among teams in proportions was: type 1: 8.8–34.7% (mean: 23.0%), type 2: 0–8.2% (mean: 3.5%), type 3: 1.7–15.6% (mean: 6.9%), type 4: 1.8–16.3% (mean: 8.6%). The range in proportions of patients using this drug given an indication was 49.0–90.9% (mean: 68.8%). These figures were lower in early intervention teams.Conclusions: The proportion of patients in FACT-teams who have an unfulfilled indication for clozapine is 6.9%. There were considerable differences between teams with respect to this proportion. Almost a third of the outpatients had at any time an indication for clozapine. If one takes type 4 patients into account, this proportion may be higher.Registration number: NTR5135 http://www.trialregister.nl/trialreg/index.asp |
| first_indexed | 2024-12-23T09:59:18Z |
| format | Article |
| id | doaj.art-4b40d463fe6944dfa5446451c32f5537 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-23T09:59:18Z |
| publishDate | 2018-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-4b40d463fe6944dfa5446451c32f55372022-12-21T17:51:18ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402018-06-01910.3389/fpsyt.2018.00231375178Prescription and Underprescription of Clozapine in Dutch Ambulatory CareYvonne C. van der Zalm0Yvonne C. van der Zalm1Fabian Termorshuizen2Peter F. Schulte3Peter F. Schulte4Jan P. Bogers5Jan P. Bogers6Machteld Marcelis7Machteld Marcelis8Iris E. Sommer9Jean Paul Selten10Jean Paul Selten11Department of Psychosis Research, Rivierduinen Psychiatric Institute, Leiden, NetherlandsDepartment of Psychiatry and Neuropsychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, NetherlandsDepartment of Psychosis Research, Rivierduinen Psychiatric Institute, Leiden, NetherlandsDutch Clozapine Collaboration Group, Castricum, NetherlandsMental Health Service Noord-Holland Noord, Alkmaar, NetherlandsDepartment of Psychosis Research, Rivierduinen Psychiatric Institute, Leiden, NetherlandsDutch Clozapine Collaboration Group, Castricum, NetherlandsDepartment of Psychiatry and Neuropsychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, NetherlandsResearch Department, Institute for Mental Health Care Eindhoven, Eindhoven, NetherlandsDepartment of Neuroscience and Department of Psychiatry, University Medical Center Groningen, Groningen, NetherlandsDepartment of Psychosis Research, Rivierduinen Psychiatric Institute, Leiden, NetherlandsDepartment of Psychiatry and Neuropsychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, NetherlandsPurpose: To our knowledge, no study has examined in a structured way the extent of underprescription of clozapine in ambulatory patients with Non-Affective Psychotic Disorder (NAPD). In the Netherlands, psychiatric care for such patients is provided by Flexible Assertive Community Treatment (FACT) teams and by early intervention teams. In 20 FACT teams and 3 early intervention teams we assessed the proportion of patients who: use clozapine (type 1 patients), previously used this drug (type 2), have an unfulfilled indication for this drug, by type of indication (type 3), or were at least markedly psychotic, but had not yet received two adequate treatments with other antipsychotic drugs (type 4). We expected to find major differences between teams. To rule out that these differences are caused by differences in severity of psychopathology, we also calculated the proportions of patients who use clozapine given an indication at any time (number of type 1 patients divided by the sum of type 1, 2, and 3 patients).Materials and methods: The nurse practitioner of each team identified the patients already on clozapine. Next, using a highly-structured decision tree, the nurse practitioner and psychiatrist assessed whether the remaining patients had an indication for this drug. Indications were treatment-resistant positive symptoms, tardive dyskinesia, aggression and suicidality. The severity of positive symptoms was determined using the Clinical Global Impression-Schizophrenia Scale (CGI-SCH).Results: In the participating FACT-teams 2,286 NAPD patients were assessed. The range among teams in proportions was: type 1: 8.8–34.7% (mean: 23.0%), type 2: 0–8.2% (mean: 3.5%), type 3: 1.7–15.6% (mean: 6.9%), type 4: 1.8–16.3% (mean: 8.6%). The range in proportions of patients using this drug given an indication was 49.0–90.9% (mean: 68.8%). These figures were lower in early intervention teams.Conclusions: The proportion of patients in FACT-teams who have an unfulfilled indication for clozapine is 6.9%. There were considerable differences between teams with respect to this proportion. Almost a third of the outpatients had at any time an indication for clozapine. If one takes type 4 patients into account, this proportion may be higher.Registration number: NTR5135 http://www.trialregister.nl/trialreg/index.asphttps://www.frontiersin.org/article/10.3389/fpsyt.2018.00231/fullclozapinepsychotic disordersoutpatient careprescription ratestreatment resistance |
| spellingShingle | Yvonne C. van der Zalm Yvonne C. van der Zalm Fabian Termorshuizen Peter F. Schulte Peter F. Schulte Jan P. Bogers Jan P. Bogers Machteld Marcelis Machteld Marcelis Iris E. Sommer Jean Paul Selten Jean Paul Selten Prescription and Underprescription of Clozapine in Dutch Ambulatory Care Frontiers in Psychiatry clozapine psychotic disorders outpatient care prescription rates treatment resistance |
| title | Prescription and Underprescription of Clozapine in Dutch Ambulatory Care |
| title_full | Prescription and Underprescription of Clozapine in Dutch Ambulatory Care |
| title_fullStr | Prescription and Underprescription of Clozapine in Dutch Ambulatory Care |
| title_full_unstemmed | Prescription and Underprescription of Clozapine in Dutch Ambulatory Care |
| title_short | Prescription and Underprescription of Clozapine in Dutch Ambulatory Care |
| title_sort | prescription and underprescription of clozapine in dutch ambulatory care |
| topic | clozapine psychotic disorders outpatient care prescription rates treatment resistance |
| url | https://www.frontiersin.org/article/10.3389/fpsyt.2018.00231/full |
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