Differences between physicians' and nurse practitioners' viewpoints on reasons for clozapine underprescription

• Published in: Brain and behavior Vol. 9; no. 7; pp. e01318 - n/a
• Main Authors: Okhuijsen‐Pfeifer, Cynthia, Cohen, Dan, Bogers, Jan P. A. M., Vos, Cato M. H., Huijsman, Elianne A. H., Kahn, René S., Luykx, Jurjen J.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.07.2019; John Wiley and Sons Inc; Wiley
• Subjects: Adult; antipsychotic agents; Antipsychotic Agents - therapeutic use; Antipsychotics; Attitude of Health Personnel; Blood tests; Clinical medicine; clozapine; Clozapine - therapeutic use; Female; Humans; Male; Middle Aged; Nurse practitioners; Nurse Practitioners - statistics & numerical data; Original Research; Patients; physician's practice patterns; Physicians; Physicians - statistics & numerical data; Practice Patterns, Physicians' - statistics & numerical data; Psychiatrists; Questionnaires; Schizophrenia; Schizophrenia - drug therapy; schizophrenia spectrum and other psychotic disorders; Standard deviation; Surveys and Questionnaires; Systematic review; Belgium; Netherlands; clozapine; physician's practice patterns; nurse practitioners; antipsychotic agents; schizophrenia spectrum and other psychotic disorders
• ISSN: 2162-3279; 2162-3279
• DOI: 10.1002/brb3.1318

Introduction Clozapine (CLZ) is the only proven effective therapy for treatment‐resistant schizophrenia, but it is underutilized across the globe. Previous findings suggest a lack of experience with CLZ prescription and concerns about CLZ's pharmacological characteristics are the prime reasons for CLZ underutilization. To our knowledge, it is currently unknown whether the reasons for underutilization and suggested solutions differ between physicians and nurse practitioners. Such differences are important as nurse practitioners are becoming increasingly involved in prescribing CLZ. Methods To examine to what degree physicians and nurse practitioners differ with regard to their take on reasons for CLZ underutilization and suggested solutions, an online questionnaire was distributed to physicians and nurse practitioners. The primary outcome was to compare the patient‐related and prescriber‐related reasons for CLZ underprescription between physicians and nurse practitioners, while secondary outcome measures included the potential solutions to prevent this underprescription. Results Physicians (N = 112) and nurse practitioners (N = 41) agreed that the two most common reasons for underprescription (patient‐related and prescriber‐related) were refusal to undergo regular blood tests and side‐effect concerns. They also agreed that the third most common prescriber‐related reason was medical complications. Physicians rated patients' unwillingness to switch medication as the third most common reason for CLZ underprescription, whereas nurse practitioners rated refusal to undergo baseline bloodtests as the third most common reason. The solutions to reduce underprescription largely corresponded between both groups. Conclusions We conclude that slight differences exist between physicians' and nurse practitioners' viewpoints on patient‐related and prescriber‐related reasons for CLZ underprescription. Future research projects should involve patients to elucidate whether the patient‐related factors put forward by prescribers align with the patients' opinions. This article investigates potential differences between physicians and nurse practitioners in CLZ underprescription and solutions. It was found that most reasons align between the physicians and nurse practitioners but there are differences that should be taken into account during future research and implementation of solutions to reduce CLZ underprescription.