Gan Yuh-Lin, O'Reilly Claire L
The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Pharmacy and Bank Building A15, The University of Sydney, Sydney, NSW, 2006, Australia.
Int J Clin Pharm. 2018 Oct;40(5):1116-1130. doi: 10.1007/s11096-018-0676-y. Epub 2018 Jun 23.
Background Clozapine is very effective for treatment-resistant schizophrenia, but its use has been limited due to the risk of agranulocytosis. From July 2015, clozapine has been accessible from Australian community pharmacies following regulatory changes, but pharmacists' attitudes towards these changes remain unknown. Objective To explore pharmacists' perspectives and experiences in supplying clozapine. Setting Australian community pharmacists. Methods A cross-sectional study with a mixed methods approach involving two phases. An online survey containing Likert-type and open-response questions was distributed to community pharmacists (n = 134) via ClopineCentral™ (clozapine monitoring system). Participants were then invited to participate in semi-structured telephone interviews (n = 12) regarding clozapine supply. Quantitative data were statistically analysed, while qualitative responses were thematically content-analysed. Main outcome measures Pharmacists' responses to surveys and interviews. Results Community pharmacists were supportive towards supplying clozapine as it increased access for consumers. Better patient-pharmacist relationships and holistic care approach were identified to benefit both consumers and pharmacists. Pharmacists reported to be confident (89.6%), have adequate support (73.1%), knowledge (86.6%) and skills (93.3%) in dispensing clozapine. Training and support received facilitated pharmacists' roles, whereas administrative issues, especially in obtaining valid haematology results, posed challenges. Educational and technical improvements were suggested to improve service provision. Conclusion Community pharmacists welcomed the regulatory changes positively and were confident in supporting consumers taking clozapine. Despite challenges present, benefits and facilitators identified supported the feasibility of this service in community pharmacies. Future research should explore other aspects of clozapine supply, such as attitudes of other stakeholders, to improve current supply systems.
氯氮平对难治性精神分裂症非常有效，但由于存在粒细胞缺乏症的风险，其应用受到限制。自2015年7月起，随着监管政策的变化，澳大利亚社区药房开始提供氯氮平，但药剂师对这些变化的态度尚不清楚。目的：探讨药剂师在供应氯氮平方面的观点和经验。研究对象：澳大利亚社区药剂师。方法：采用横断面研究，混合方法包括两个阶段。通过ClopineCentral™（氯氮平监测系统）向社区药剂师（n = 134）分发了一份包含李克特式和开放式问题的在线调查问卷。然后邀请参与者参加关于氯氮平供应的半结构化电话访谈（n = 12）。对定量数据进行统计分析，对定性回答进行主题内容分析。主要观察指标：药剂师对调查和访谈的回答。结果：社区药剂师支持供应氯氮平，因为这增加了消费者的可及性。改善患者与药剂师的关系以及整体护理方法对消费者和药剂师都有益。药剂师报告称在调配氯氮平方面有信心（89.6%）、有足够的支持（73.1%）、知识（86.6%）和技能（93.3%）。所接受的培训和支持促进了药剂师的工作，而行政问题，尤其是获取有效的血液学结果方面，构成了挑战。建议进行教育和技术改进以改善服务提供。结论：社区药剂师对监管变化持积极态度，并对支持服用氯氮平的消费者充满信心。尽管存在挑战，但所确定的益处和促进因素支持了社区药房提供这项服务的可行性。未来的研究应探索氯氮平供应的其他方面，如其他利益相关者的态度，以改善当前的供应系统。
