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  • Implementing a clozapine supply service in Australian community pharmacies: barriers and facilitators

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    Wilson246689.pdf (746.7Kb)
    Author(s)
    Wilson, Bethany
    McMillan, Sara S
    Wheeler, Amanda J
    Griffith University Author(s)
    McMillan, Sara S.
    Wheeler, Amanda
    Wilson, Bethany
    Year published
    2019
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    Abstract
    Background: Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, although serious adverse effects such as agranulocytosis and cardiomyopathy limit its use. In July 2015, Australian regulations changed to allow community-based prescribing and supply of clozapine for maintenance therapy. However, there is currently no information on the rate of clozapine services available in Australian community pharmacies, or the factors that influence a pharmacist’s decision to provide, or not provide, a clozapine service, particularly from the perspective of those pharmacists who do not offer this service. ...
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    Background: Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, although serious adverse effects such as agranulocytosis and cardiomyopathy limit its use. In July 2015, Australian regulations changed to allow community-based prescribing and supply of clozapine for maintenance therapy. However, there is currently no information on the rate of clozapine services available in Australian community pharmacies, or the factors that influence a pharmacist’s decision to provide, or not provide, a clozapine service, particularly from the perspective of those pharmacists who do not offer this service. This study investigated Australian community pharmacies providing a clozapine supply service and the barriers to, and facilitators of, implementing this service. Methods: This mixed method exploratory study was conducted in two stages: (1) a brief online survey of community pharmacists Australia-wide; and (2) semi-structured telephone interviews. The survey was conducted between November 2017–January 2018; results were analysed via descriptive statistics. Survey respondents who did not provide a clozapine service were eligible to participate in a telephone interview exploring barriers and facilitators. Interviews were undertaken between December 2017–January 2018 and data analysed thematically. Results: A total of 265 pharmacists completed the survey; 51.3% (n = 136) provided a clozapine service. Consumer demand was a key facilitator (n = 18/247; 66.1%) and the main barrier to implementing a clozapine service was a perceived lack of need (n = 70/122; 57.4%). Twelve survey respondents were interviewed; while most participants acknowledged that supplying clozapine in community pharmacies would benefit consumers due to convenience, the lack of training and support led to difficulties in service implementation. Conclusions: Although regulatory changes aimed to improve access to clozapine, it is unclear if they have been successful, or to what degree. Community pharmacists were positive about supplying clozapine in the community but identified a need for training and support to raise awareness of the service so that eligible clozapine consumers can be transitioned to community-based care. Further research is needed about the perceptions of clozapine consumers to determine whether the regulatory changes have resulted in positive outcomes for their independence and quality of life.
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    Journal Title
    Journal of Pharmaceutical Policy and Practice
    Volume
    12
    DOI
    https://doi.org/10.1186/s40545-019-0180-3
    Copyright Statement
    © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
    Subject
    Public Health and Health Services
    Pharmacology and Pharmaceutical Sciences
    Australia
    Clozapine
    Community pharmacy
    Schizophrenia
    Treatment burden
    Publication URI
    http://hdl.handle.net/10072/386646
    Collection
    • Journal articles

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