Grant A, McManus R, Belay H, Mahon M, Murad F, O' Donoghue B, Lally J
National Forensic Mental Health Service Facility, Dublin, Ireland.
Department of Psychiatry, Connolly Hospital, Dublin, Ireland.
Ir J Psychol Med. 2024 Oct 2:1-7. doi: 10.1017/ipm.2024.35.
Despite proven effectiveness in refractory schizophrenia, clozapine remains underutilised, and it is important to understand potential reasons for this. This study's aim was to examine in a National sample of Consultant Psychiatrists their knowledge of, attitudes and perceived barriers to clozapine use.
A novel questionnaire was designed and distributed by email to 275 Consultant Psychiatrists in Republic of Ireland.
Twenty-eight percent ( = 77) completed the survey, with 55% of respondents practicing for 15 or more years. Clinicians expressed confidence in managing clozapine treatment and side effects and were well aware of clozapine's clinical effectiveness and guideline-based use. A majority indicated insufficient experience managing rechallenge and half expressed insufficient experience managing adverse events. Perceived patient factors were highlighted as barriers with 69% of respondents reporting patients' concern about effectiveness and 50% regarding tolerability. Sixty-four percent ( = 40) indicated that a specialised/tertiary clozapine service would facilitate initiation, with 57% ( = 36) reporting less frequent blood monitoring would aid clozapine prescribing. A majority identified that access to dedicated staff (81%, = 51) and dedicated day hospital services (84%, = 53) would facilitate community initiation.
Consultants are familiar with clozapine use and related guidelines. Dedicated staff and facilities for clozapine use is one identified structural change to enhance clozapine prescribing in Ireland. Tertiary service or clinical advice service would assist in clozapine rechallenge cases or in managing significant adverse events. More structured patient education regarding clozapine effectiveness and professional development programmes focused on managing side effects and rechallenge may promote clozapine use.
尽管氯氮平在难治性精神分裂症的治疗中已被证明有效，但它的使用仍未得到充分利用，了解其潜在原因很重要。本研究的目的是在一个全国性的顾问精神科医生样本中，调查他们对氯氮平使用的知识、态度和感知到的障碍。
设计了一份新颖的问卷，并通过电子邮件分发给爱尔兰共和国的275名顾问精神科医生。
28%（n = 77）完成了调查，55%的受访者从业15年或更长时间。临床医生对管理氯氮平治疗和副作用表示有信心，并且充分了解氯氮平的临床疗效和基于指南的使用方法。大多数人表示在管理再次使用氯氮平方面经验不足，一半人表示在管理不良事件方面经验不足。感知到的患者因素被视为障碍，69%的受访者报告患者担心疗效，50%担心耐受性。64%（n = 40）表示专门的/三级氯氮平服务将有助于开始治疗，57%（n = 36）报告减少频繁的血液监测将有助于氯氮平的处方。大多数人认为获得专职工作人员（81%，n = 51）和专职日间医院服务（84%，n = 53）将有助于在社区开始治疗。
顾问精神科医生熟悉氯氮平的使用及相关指南。使用氯氮平的专职工作人员和设施是在爱尔兰加强氯氮平处方的一项已确定的结构性改变。三级服务或临床咨询服务将有助于处理氯氮平再次使用的病例或管理重大不良事件。关于氯氮平疗效的更系统的患者教育以及侧重于管理副作用和再次使用的专业发展计划可能会促进氯氮平的使用。
