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.
Format
Recorded webinar, non-interactive, self-paced distance learning activity with post-test.
This presentation was recorded on November 10, 2022.
Learning Objectives
- List three barriers that complicate more widespread clozapine adoption.
- Critically evaluate the current literature on what is known about clozapine clinics in the US.
- Describe three possible advantages for using a clozapine clinic model in contrast to care as usual.
- Describe two efforts that have increased clozapine utilization throughout a system.
Target Audience
Nurse/Nurse Practitioner, Pharmacist, Physician (Non-psychiatrist), Physician Assistant, Psychiatrist
Instructional Level
Introductory, Intermediate
Estimate Time to Complete
Estimated Duration: 1.0 hour
Program Start Date: July 08, 2023
Program End Date: July 08, 2026
Ongoing Interdisciplinary Discussion Board
After completing the course, engage with colleagues in the mental health field through SMI Adviser's Webinar Roundtable Topics discussion board. This is an easy way to network and share ideas with other clinicians who participate in this webinar. Access through the discussion tab.
How to Earn Credit
Participants who wish to earn AMA PRA Category 1 Credit™, nursing continuing professional development contact hours (NCPD, formerly CNE), CE credit for psychologists, CE credit for social workers, or a certificate of participation may do so by viewing the live presentation and completing the evaluation. Participants claiming CE credit for psychologists and those claiming CE credit for Social workers, must have full attendance to claim credit. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians), CE certificate (psychologists), CE certificate (social workers) or certificate of participation (other disciplines) showing the event date and hours earned.
Continuing Education Credit
Physicians
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this live event for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurses/Nurse Practitioners
The American Psychiatric Nurses Association is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.
Faculty and Planner Disclosures
The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.
Instructor
- Robert O. Cotes, MD is an Associate Professor at Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences. He serves as Co-Director of the PSTAR Clinic (Persistent Symptoms: Treatment, Assessment and Recovery), Director of Project ARROW (Achieving Recovery through Resilience, Optimism, and Wellness) and Co-Director of Open Dialogue Atlanta at Grady's Outpatient Behavioral Health Clinic. Dr. Cotes discloses research funding from Alkermes and Roche, and consultant roles with Clinical Care Options and Saladax Biomedical.
- Anna Costakis, MD, MBA is the as the Adult Ambulatory Psychiatry Director at Northwell Zucker Hillside Hospital, where she also serves as faculty at Hofstra Zucker School of Medicine. Dr. Costakis reports no financial relationships with commercial interests.
- Jessica Goren, PharmD, BCPP is a Senior Clinical Pharmacist at Psychiatric Pharmacist at Cambridge Health Alliance. Dr. Goren reports no financial relationships with commercial interests.
- Mindy Asbury, MD, PhD is Assistant Profressor at University of North Carolina School of Medicine. She also serves as Medical Director of UNC Wake ACT Team and UNC Encompass First Episode Psychosis Program, as well as Director of North Carolina Clozapine Network. Dr. Asbury reports no financial relationships with commercial interests.
Planners
- Teri Brister, PhD, LPC, National Alliance on Mental Illness. Dr. Brister reports no financial relationships with commercial interests.
- John Torous, MD, Beth Israel Deaconess Medical Center. Dr. Torous has no relevant financial relationships to disclose.
- Donna Rolin, PhD, APRN, University of Texas at Austin. Reports no financial relationships with commercial interests.
Reviewers
- Donna Rolin, PhD, APRN, University of Texas at Austin. Reports no financial relationships with commercial interests. (Reviewed on 6/15/2023)
Accessibility for Participants with Disabilities
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Technical Requirements
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- Internet Explorer 11+
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Optimal System Configuration:
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