Maryan Samantha, Harms Michelle, McAllister Erin, DeJongh Beth
Postgraduate Year 1 Pharmacy Resident, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin.
Mental Health Clinical Pharmacy Specialist, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin.
Ment Health Clin. 2019 Mar 1;9(2):70-75. doi: 10.9740/mhc.2019.03.070. eCollection 2019 Mar.
In an effort to establish clinical support for providers prescribing clozapine and to help reverse the national decline in clozapine utilization, a clinical pharmacist began seeing half the clozapine clinic patients, preceding the psychiatrist, at this facility in July 2017. The other half of the clozapine clinic patients continued being seen by the psychiatrist only. The purpose was to determine the impact of the pharmacist on clozapine management and identify barriers to clozapine use to potentially increase its utilization.
Baseline data (clozapine dose, number of antipsychotics and other psychotropics, A1c, lipids, pulse, body mass index, weight, blood pressure, and number of medications for adverse effects) were collected via chart review from the first clinic visit and each follow-up visit. A provider survey was used to identify barriers and solutions to prescribing clozapine.
There were no statistically significant differences from baseline in patient outcomes between the collaborative and psychiatrist-only group. In the prepharmacist to postpharmacist analysis, there was a decrease in number of antipsychotics (-0.27 ± 0.65), number of other psychotropics (-0.18 ± 0.41), A1c (-0.04% ± 0.25%), clozapine dose (-7.96 mg ± 19.58 mg), and total cholesterol (-15.73 mg/dL ± 42.31 mg/dL). There were more pharmacologic (71 vs 19) and nonpharmacologic (154 vs 3) interventions documented in the collaborative group compared to the psychiatrist-only group. Eleven providers (69%) completed the survey. Providers' perception of patient refusal of monitoring was the barrier that received the most responses (54%). A pharmacist seeing every clozapine clinic patient was the solution that received the most responses (90%).
Trends were seen for decreasing the number of antipsychotics, other psychotropics, A1c, and total cholesterol as well as an increased number of nonpharmacologic and pharmacologic interventions documented in the collaborative group. Providers identified that pharmacists seeing every clozapine clinic patient would be a solution to clozapine underutilization, which demonstrates the perceived value of pharmacist involvement.
为了为开具氯氮平的医疗服务提供者建立临床支持，并帮助扭转全国氯氮平使用量下降的趋势，一名临床药剂师于2017年7月开始在该机构先于精神科医生诊治一半的氯氮平门诊患者。另一半氯氮平门诊患者仍仅由精神科医生诊治。目的是确定药剂师对氯氮平管理的影响，并找出氯氮平使用的障碍，以潜在地提高其使用率。
通过查阅病历，从首次门诊就诊及每次随访就诊中收集基线数据（氯氮平剂量、抗精神病药物和其他精神药物的数量、糖化血红蛋白、血脂、脉搏、体重指数、体重、血压以及不良反应用药数量）。通过提供者调查来确定开具氯氮平的障碍和解决方案。
协作组和仅由精神科医生诊治组之间的患者结局与基线相比无统计学显著差异。在药剂师介入前与介入后的分析中，抗精神病药物数量（-0.27±0.65）、其他精神药物数量（-0.18±0.41）、糖化血红蛋白（-0.04%±0.25%）、氯氮平剂量（-7.96mg±19.58mg）和总胆固醇（-15.73mg/dL±42.31mg/dL）均有所下降。与仅由精神科医生诊治组相比，协作组记录的药物（71比19）和非药物（154比3）干预更多。11名提供者（69%）完成了调查。提供者认为患者拒绝监测是得到最多回应的障碍（54%）。药剂师诊治每位氯氮平门诊患者是得到最多回应的解决方案（90%）。
协作组出现了抗精神病药物、其他精神药物、糖化血红蛋白和总胆固醇数量减少的趋势，以及记录的非药物和药物干预增加的趋势。提供者认为药剂师诊治每位氯氮平门诊患者是解决氯氮平使用不足的一个方案，这表明了药剂师参与的可感知价值。
