Consumer access to clozapine in Australia: how does this compare to New Zealand and the United Kingdom?
Background: Clozapine is an antipsychotic medication used in treatment resistant schizophrenia. However, clozapine is associated with a significant adverse effect profile and extensive monitoring is required to optimise consumer safety. Traditionally, clozapine can only be prescribed by a psychiatrist and dispensed at a hospital or hospital affiliated pharmacy in Australia. These restrictions could result in significant treatment burden for consumers taking clozapine.
Objective: To identify (1) the different models of supply that exist for people living in the community taking clozapine in Australia and compare to those in New Zealand and the United Kingdom, and (2) explore how these supply models may impact on consumer burden from the perspective of professionals involved in the supply of clozapine.
Method: Key informants were interviewed (n=8) from Australia, New Zealand and the United Kingdom regarding how consumers, who lived in the community, accessed clozapine. Data were analysed and led to the development of four clozapine supply models. These four models were further validated by an online survey of a wider sample (n=30). Data were analysed thematically and via simple descriptive statistics.
Results: Clozapine supply varied depending on location. A secondary care model was utilised in the United Kingdom compared to a community based (primary care) model in New Zealand; Australia utilised a mixture of both secondary and primary care. A key theme from all study participants was that community pharmacy should be utilised to dispense clozapine to consumers living in the community, provided adequate training and safeguards are in place. It was noted that the utilisation of community pharmacies could improve access and flexibility, thereby reducing treatment burden for these consumers.
Conclusion: There are predominately two models for supply of clozapine to consumers living in the community in Australia, New Zealand and the United Kingdom. One model utilises secondary care facilities and the other community services. Community pharmacy is ideally placed to increase access to clozapine for consumers living in the community, provided appropriate training and support is given to pharmacists providing this professional service.
2. Therapeutic Guidlines Ltd. Schizophrenia and related psychoses. eTG complete [internet] ed. Melbourne 2015.
3. Bleakley S, Taylor D. Clozapine Handbook. Warwickshire United Kingdom: Llyod-Reinhold; 2013.
4. Malalagama G, Bastiampillai T, Dhillon R. Clozapine use in Australia. Australas Psychiatry. 2011;19(2):175. doi: 10.3109/10398562.2010.525646
5. Fakra E, Azorin JM. Clozapine for the treatment of schizophrenia. Expert Opin Pharmacother. 2012;13(13):1923-1935. doi: 10.1517/14656566.2012.709235
6. Asenjo Lobos C, Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Leucht S. Clozapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev. 2010;(11):CD006633. doi: 10.1002/14651858.CD006633.pub2
7. Sav A, King MA, Whitty JA, Kendall E, McMillan SS, Kelly F, Hunter B, Wheeler AJ. Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect. 2015 Jun;18(3):312-324. doi: 10.1111/hex.12046
8. Barnett AH, Chaudhry I, Farooqi A, Gadsby R, Heald A, Hill J, Jones PB, Mackin P, Millar H, Peveler R, Rees A, Singh V, Taylor D, Vora J. Minimising metabolic and cardiovascular risk in schizophrenia: diabetes, obesity and dyslipidaemia. J Psychopharmacol. 2007;21(4):357-373.
9. Pharmacies in Australia: Market Research Report: IBISWorld; 2015. Available at: http://www.ibisworld.com.au/industry/default.aspx?indid=1878 (accessed January 21, 2016).
10. Crump K, Boo G, Liew FS, Olivier T, So C, Sung JY, Wong CH, Shaw J, Wheeler AJ. New Zealand community pharmacists' views of their roles in meeting medicine-related needs for people with mental illness. Res Social Adm Pharm. 2011;7(2):122-33. doi: 10.1016/j.sapharm.2010.03.006
11. Wheeler A, Fowler J, Hattingh L, Kelly F. Exploring the role of community pharmacy in supporting mental health consumers and carers. [Research Report]. Available from: http://6cpa.com.au/resources/fifth-agreement-rd/mental-health-project/ (accessed January 21, 2016).
12. Thompson L, McCabe R. The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC Psychiatry. 2012;12:87. doi: 10.1186/1471-244X-12-87
13. Philpott L. Mental health: Make a difference. Aust J Pharm. 2014;95(1133):36-40.
14. Zygmunt A, Olfson M, Boyer CA, Mechanic D. Interventions to improve medication adherence in schizophrenia. Am J Psychiatry. 2002;159(10):1653-1664.
15. Liamputtong P. Qualitative Research Methods. Australia: Oxford University Press; 2013. ISBN: 9780195518559
16. Clozaril Patient Monitoring System Protocol. Novartis Pharmaceuticals 2015. Available from Novartis Pharmaceuticals Australia.
17. Clopine Connect. Hospira; 2015. Available from Hospira
18. Dixon M, Dada C. How clozapine patients can be monitored safely and effectively. Pharm J. 2014;6(5):131.
19. Monitoring Frequency and Overdue Notifications. Novartis Pharmaceutics 2014 [Cited 2016] Available from Novartis Pharmaceuticals UK
20. Community Pharmacy Services Agreement 2012: TAS. Available at: http://centraltas.co.nz/assets/Publications/Pharmacy-Documents/Implementing-the-CPSA/Community+Pharmacy+Services+Agreement+generic+version.pdf (accessed January 21, 2016).
21. Medicines Regulation of 1984, NZ [Available at: http://www.legislation.govt.nz/regulation/public/1984/0143/latest/DLM95668.html (accessed June 22, 2016)
22. Treating patients on Clozapine [webpage]. South Australia Health. Available at: http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/medicines+and+drugs/clozapine/treating+patients+on+clozapine (accessed June 22, 2016)
23. O'Reilly CL, Bell JS, Kelly PJ, Chen TF. Exploring the relationship between mental health stigma, knowledge and provision of pharmacy services for consumers with schizophrenia. Res Social Adm Pharm. 2015;11(3):e101-e109. doi: 10.1016/j.sapharm.2013.04.006
24. Clozaril Product Information AUSDI: Phoneix Medical Publishing Pty Limited.
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.