The US Food and Drug Administration (FDA) indications for clozapine use include treatment-resistant schizophrenia (TRS) and reducing suicidal behavior in patients with schizophrenia or schizoaffective disorder. Although approximately one-fourth of people with schizophrenia experience TRS (defined as the failure of two antipsychotic trials at an adequate dose and duration), clozapine is only prescribed to 4% of people with schizophrenia in the US.
Barriers for clozapine’s more widespread use can be divided into patient, prescriber, and administrative barriers. Administrative barriers include challenges with clozapine REMS, coordination issues from inpatient to outpatient settings, difficulties with reimbursement, and a lack of specialized clinics. Studies have highlighted the importance of developing clozapine clinics, which could expand access and include experienced clinicians that would effectively manage adverse events. A recent survey from SMI Adviser that included 32 clozapine clinics found there was significant variation in the staffing models and services offered. Over half of clozapine clinics surveyed included psychiatrists, pharmacists, nurses, psychiatric nurse practitioners, and case managers. The median caseload of patients on clozapine in the clinics was 45.
In this webinar, we will first present an overview of the barriers of clozapine use in the US, summarize possible advantages of organizing services into clozapine clinics, and discuss the current literature what is known about these clinics. The webinar will then move to a panel discussion of three system leaders to discuss how their programs are organized, successes, challenges, and future directions. Finally, we will explore what wider solutions may increase clozapine utilization across individual states.