Practitioner attitudes to clozapine initiation
Practitioner attitudes to clozapine initiation
复制标题
DOI：
10.1111/acps.12193
复制
发表时间：
2014-07-01
影响因子：
6.7
通讯作者：
Taylor, D.
中科院分区：
文献类型：
--
作者：
Gee, S.;Vergunst, F.;Taylor, D.
目的：氯氮平是治疗难治性精神分裂症最有效的抗精神病药物。国家和地方指南推荐将其作为精神分裂症的三线治疗。尽管如此，它仍未得到充分利用。这项调查旨在澄清处方障碍并阐明可能改善患者获得氯氮平的因素。方法：向南伦敦和莫兹利 NHS 基金会信托基金的所有工作人员提供了一份调查问卷。结果：总共有 144 名临床工作人员完成了调查问卷。大多数（81%）受访者“相当”或“非常”熟悉氯氮平处方指南。最常被认为是“非常频繁”的问题的处方障碍是患者对氯氮平耐受性的担忧或患者拒绝坚持血液检测监测。工作人员还认为，医疗并发症经常妨碍氯氮平处方。专门负责氯氮平起始治疗的工作人员或日间医院安排被认为是最有可能增加氯氮平处方的因素。结论：专业人员认为处方的主要障碍是以患者为中心 - 拒绝血液检测监测或对耐受性的担忧。临床医生对依从性或医疗并发症的担忧也很重要。专门负责启动氯氮平的门诊服务的发展可能有助于增加治疗早期开出氯氮平处方的频率
Objective: Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia. It is recommended as third-line treatment for schizophrenia in national and local guidelines. Despite this, it is underutilised. This survey aimed to clarify barriers to prescribing and elucidate factors that may improve patient access to clozapine.Method: A questionnaire was made available to all staff members at South London and Maudsley NHS Foundation Trust.Results: In total, 144 clinical staff completed the questionnaire. The majority (81%) of respondents were 'fairly' or 'very' familiar with clozapine prescribing guidelines. Barriers to prescribing most commonly stated as being 'very frequently' a problem were patient concerns about tolerability of clozapine or patient refusal to adhere to blood test monitoring. Staff members also felt medical complications frequently prevented clozapine prescription. Dedicated staff or day hospital placements devoted to clozapine initiation were identified as factors most likely to increase prescribing of clozapine.Conclusion: Professionals identified the dominant barriers to prescribing as being patient focussed - refusal of blood test monitoring or concerns about tolerability. Clinician fears about compliance or medical complications were also important. The development of outpatient services specifically tasked with initiating clozapine may help to increase the frequency of prescribing of clozapine earlier in treatment