What are the barriers and facilitators of clozapine use in early psychosis? A survey of UK early intervention clinicians

Abstract

Clozapine is the most effective medication for treatment-resistant psychosis, but evidence points to substantial underuse, especially within early intervention psychosis (EIP) services. We explored clinicians’ views on perceived barriers and facilitators to offering patients clozapine within EIP services. A cross-sectional survey was distributed electronically to clinicians practising in EIP services across England. A mixed methods approach was used to assess barriers to clozapine, and attitudes and opinions concerning clozapine underutilisation. Based on the barriers identified in the literature, clinicians were asked to rate each one (scale:1-7) based on importance, with a higher score indicating higher importance. Clinicians were also asked open-ended questions on barriers to clozapine and how access can be improved in EIP services. Quantitative data were analysed using descriptive and inferential statistics, and qualitative responses were analysed thematically. One hundred and nineteen EIP clinicians from 35 services in England completed the survey. In total, 37% (n = 45) of clinicians perceived that clozapine was under-prescribed in their EIP service. The most important barrier to utilising clozapine were patient concerns with side effects, followed by monitoring requirements and clinician concerns with side effects. Thematic analysis identified 17 perceived barriers, which were grouped into three major themes: administrative (5 subthemes), clinician-related (6 subthemes), and patient-related (6 subthemes). Perceived facilitators to improving clozapine use were greater training, improved resources, and optimised monitoring. The main barriers to clozapine in EIP services, as identified by clinicians, are patient concerns regarding side effects and monitoring requirements. Identified facilitators for improved clozapine use include clinician training, improved resources, guidelines, and point-of-care testing.

Survey on barriers to psychiatrists’ use of clozapine for young people in Scotland and suggestions for reducing these

“…Previous research has looked at clinician attitudes to clozapine prescription [ 2 , 9 , 17 ]. The main perceived barriers to clozapine use in early intervention for psychosis services included patient concerns about side effects and physical health monitoring requirements [ 9 ].…”

“…Previous research has looked at clinician attitudes to clozapine prescription [ 2 , 9 , 17 ]. The main perceived barriers to clozapine use in early intervention for psychosis services included patient concerns about side effects and physical health monitoring requirements [ 9 ]. A 2005 study involving CAMHS consultants across the United Kingdom’s clozapine prescription practice concluded that unfamiliarity with the drug and the need for monitoring of side-effects seem to negatively influence use, and it might be that clearer information about effectiveness and prescribing practices would result in increased usage [ 2 ].…”

“…An online survey was developed by two authors (GW and HS) following guidelines for electronic survey design [ 8 ]. Previous research studies on clinician attitudes to clozapine were considered during the design process [ 2 , 9 ]. Prior to distributing the survey, it was presented to the RCPsychiS CaAF executive committee, with feedback used to further improve the final design.…”