Non-prescribing of clozapine for outpatients with schizophrenia in real-world settings: The clinicians' perspectives.

IF 3 Q2 PSYCHIATRY Schizophrenia (Heidelberg, Germany) Pub Date : 2023-12-22 DOI:10.1038/s41537-023-00423-3
Michelle Iris Jakobsen, Stephen Fitzgerald Austin, Ole Jakob Storebø, Jimmi Nielsen, Erik Simonsen
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Abstract

Clozapine is the gold standard for treating treatment-resistant schizophrenia although continuously underutilized. Previous surveys of clinicians have found that some of the most frequently cited barriers to clozapine prescribing are related to the blood-monitoring requirements. However, these surveys tend to explore general perspectives and may not reflect the true impact of different barriers in real-world outpatient settings. This study aimed to explore this issue. First, by surveying the clinicians responsible for the treatment of 39 clozapine-eligible, yet clozapine-naive, outpatients with schizophrenia. Then, based on the survey results, explanatory interviews with the participating psychiatrists were conducted and analyzed thematically. The most frequently cited reason for non-prescribing of clozapine was the expected non-compliance with blood-monitoring requirements; however, overall stability and/or severe mental illness was chosen as the most important reason in most patient-cases. The qualitative analysis highlighted the combined impact of standard clinical practice, personal experiences, and organizational constraints on clozapine utility.

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在现实环境中,精神分裂症门诊患者不使用氯氮平:临床医生的观点。
氯氮平是治疗耐药性精神分裂症的金标准,但一直未得到充分利用。此前对临床医生进行的调查发现,氯氮平处方中最常被提及的一些障碍与血液监测要求有关。然而,这些调查倾向于探讨一般观点,可能无法反映不同障碍在实际门诊环境中的真实影响。本研究旨在探讨这一问题。首先,调查了负责治疗 39 名符合氯氮平治疗条件但未服用氯氮平的门诊精神分裂症患者的临床医生。然后,根据调查结果对参与调查的精神科医生进行解释性访谈,并进行专题分析。不开具氯氮平处方的最常见原因是预期不符合血液监测要求;然而,在大多数患者病例中,整体稳定性和/或严重精神疾病被选为最重要的原因。定性分析强调了标准临床实践、个人经历和组织限制对氯氮平使用的综合影响。
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