Cross-sector user and provider perceptions on experiences of shared-care clozapine: a qualitative study

Abstract

Objectives(1) To explore individual perceptions on experiences of people receiving and/or delivering a shared-care clozapine serviceand (2) to gain an understanding of effectiveness and acceptability of shared-care clozapine.DesignInterpretative phenomenological analysis guided the delivery and analysis of a semistructured interview and focus group study designed to explore participant experience of shared-care clozapine. Ethical approval 13/EM/0286 was gained in July 2013 from East Midlands—Nottingham 1 REC.ParticipantsEight stakeholder groups from Adult and Forensic Mental Health involved in shared-care clozapine provision delivered in primary care were identified for recruitment from one mental health trust in England (six different groups of healthcare professionals (HCPs), clozapine service users (CSUs) and their carers). To be eligible for recruitment, all potential participants had to be either providing, receiving or the carer of a person receiving clozapine by shared care.Results32 HCPs and 6 CSUs were recruited and 14 interviews and 6 participant homogenous focus groups were run. Four shared superordinate themes were identified: Clozapine Process, The Sharing of Care, The Provision of Care and Multi-professional Relationships. Differences between Adult and Forensic engagement in shared care were noted and both HCP and CSU relationships were mapped to the Wish conceptual framework of relationships to provide insight into how shared-care clozapine can provide a mechanism for provision of person-centred care, which was present in the Forensic HCP–CSU but not General Adult HCP–CSU relationship.ConclusionsThe Forensic HCP/CSU relationship demonstrated how cross-sector working through shared-care clozapine can provide a mechanism for provision of person-centred care by enabling a person-centred focus to care delivery which supported CSUs to live as independently as possible. Person-centred care demonstrably improves patient care outcomes and wider implementation of shared-care clozapine could provide greater integration of people with serious mental illness and reduce stigma within the community while improving patient outcomes.

Clozapine shared care: mental health services and GPs working together for better outcomes for people with schizophrenia

“…To our knowledge, little research on such programs has been undertaken in an Australian context, but at least one study has shown successful outcomes from a clozapine shared care program, with almost no re‐hospitalisations in the year following transfer to the program 14 . Also, studies conducted in Australia and the United Kingdom have shown high degrees of satisfaction with clozapine shared care among patients and health care workers 11,16 . The program that we have described is successful due to the clear delineation of roles and responsibilities, contingency planning, and mutual partnerships between primary and secondary care, with all parties having access to the service’s clozapine policy (which outlines the program in detail).…”

A qualitative exploration of the barriers to and facilitators of clozapine monitoring in a secure psychiatric setting

“…This mirrors the findings of a previous evaluation of community shared-care clozapine monitoring, where forensic healthcare professionals were motivated by enabling patients to develop skills for independence. 7 Both staff and patients believed that physical and mental healthcare were equally important for people taking clozapine. 7 In our study, there was a range of understanding among patients, with stepdown patients having greater understanding of the associated benefits of monitoring.…”

“…7 Both staff and patients believed that physical and mental healthcare were equally important for people taking clozapine. 7 In our study, there was a range of understanding among patients, with stepdown patients having greater understanding of the associated benefits of monitoring. Their engagement is a further key facilitator to be harnessed.…”

“…First, it is essential that staff and patients perceive clozapine monitoring as a tool for facilitating patient recovery, independence and safety, and not simply as the process for supplying a medication. 7 Patient education should not be a one-off event but should be repeated throughout treatment, especially as patients may be unwell at the time of clozapine initiation and have low health literacy. 14 Clozapine monitoring must be supported by care pathways and effective interventions to ensure that, first, monitoring takes place and, second, that abnormal findings are actioned.…”

“…2,5,6 A previous evaluation of shared-care clozapine monitoring found that implementing a different model of monitoring could feel process-driven and generate anxiety for staff, with a recommendation to identify facilitators and barriers to ensure that change is successful and sustained. 7 Therefore, in this study, we aimed to explore the beliefs and understanding of staff and patients at a secure mental health unit regarding clozapine monitoring, and to use this information to identify barriers to and facilitators of monitoring.…”