title: Demonstrating the effectiveness of less restrictive care pathways for the management of patients treated with clozapine.
abstract: OBJECTIVE
  The purpose of this study was to measure the effectiveness of two alternative care pathways for managing patients treated with clozapine.
  
  
  METHODS
  Medical records for 90 clozapine patients managed via three care pathways were audited for a 24 month period (30 per group). The three care pathways established to manage patients prescribed clozapine include: (1) remaining in public mental health service case management; (2) transitioning to general practitioner-mental health service shared care; or (3) transitioning to private psychiatry sole care. Demographic, illness, medication compliance, service utilisation and performance on clinical outcome measures were collected in the 12 months prior to and following transition.
  
  
  RESULTS
  Across both the private psychiatry and general practitioner (GP) shared care transitioned groups, only one patient had a psychiatric hospital admission in the 12 months following transition, and transitioned patients also had fewer mental health service clinician contacts. Good medication compliance, better skills of daily living, lower levels of illicit substance abuse and a lower intensity of case management history were seen in transitioned patients.
  
  
  CONCLUSIONS
  Transitioning appropriate patients taking clozapine to less intensive care pathways like private psychiatrists and GP shared care can be effectively achieved if appropriate supports are in place for both the clinicians and their patients.
authors.affiliation: Research Fellow, Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Sacha
authors.initials: S
authors.lastname: Filia
authors.forename: Stuart
authors.initials: S
authors.lastname: Lee
authors.forename: Kelly
authors.initials: K
authors.lastname: Sinclair
authors.forename: Alyson
authors.initials: A
authors.lastname: Wheelhouse
authors.forename: Sally
authors.initials: S
authors.lastname: Wilkins
authors.forename: Anthony
authors.initials: A
authors.lastname: de Castella
authors.forename: Jayashri
authors.initials: J
authors.lastname: Kulkarni
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D005791:Patient Care; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy; D012565:Schizophrenic Psychology; D019966:Substance-Related Disorders / Q000150:complications
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine
keywords: GP shared care; clozapine; models of care; outcomes of care; private psychiatry