W.L.A.LEO1, J.LEE1, S.S.ZHENG1, C.TANG1, E.K.S.LIEW1, B.T.NG1
Institute of Mental Health1
The collaborative clozapine clinic in IMH started in 2011 with specialised psychiatric pharmacists and psychiatrists co-managing outpatients on maintenance clozapine therapy. This study aims to evaluate the clinical outcomes of outpatients co-managed in this clinic over a 5-year period.
Data, including socio-demographics, employment, diagnoses, daily doses of clozapine and co-prescribed antipsychotics in chlorpromazine equivalence (CPZeq), compliance to routine blood tests and psychiatric rating scores were extracted from the medical records of co-managed patients on clozapine from Oct 2011 – Sep 2016.
Sixty-seven cases were reviewed; 52% were females, 82% Chinese, mean age of 41.1 (SD: 10.5) years. Mean daily clozapine dose was 255.6mg (SD: 106.3mg); one-quarter of them were on adjunctive antipsychotics of 105.5 mg CPZeq (SD: 107.0mg). About one-third were employed. The most common diagnosis was schizophrenia (97%), followed by and schizoaffective disorder (3%). Average duration of follow-up was 1.8 years. Between their first and last visit with the psychiatric pharmacist, the two-tailed Wilcoxon matched pairs signed-rank test detected no significant differences in the scores on the Clinical Global Impressions–Severity (CGI-S) scale and the 4-item Positive Symptoms Rating Scale (PSRS). None of the patients had readmissions or relapses. All were compliant to routine full blood count monitoring.
The collaborative clozapine clinic model with pharmacists practicing alongside psychiatrists is effective in maintaining stability of patients on clozapine. This opens up new opportunities for pharmacists to be more involved in psychiatric care.