Comparison of sole nurse and team-delivered community clozapine services for people with treatment-resistant schizophrenia.
OBJECTIVE
To compare sole nurse and doctor-led multidisciplinary team delivery of community clozapine services for people with treatment-resistant schizophrenia.


BACKGROUND
Around 20% of people with schizophrenia are treatment resistant and fail to respond to front line medications. Clozapine, a second-line treatment, has potentially serious side effects requiring regular monitoring. Different models of community clozapine services are emerging in the British National Health Service, but there is little evidence about which is best.


METHODS
Questionnaire survey of service users.


METHODS
All patients on the lists of seven clozapine clinics (four sole nurse, three multidisciplinary team) in one trust were invited to participate, 2009-2010. Forward stepwise regression was used to investigate associations between patient well-being, functioning, self-efficacy and satisfaction, and clinic model attended, controlling for socio-demographic and health characteristics and processes of care. Use (and costs) of other health and social services accessed was compared between models.


RESULTS
Sixty-six service users (35% participation rate) responded. Well-being and functioning were associated with patient characteristics and processes of care, not clinic model. Patients managed by sole nurses reported, over 3 months: more community psychiatric nurse visits and hospital psychiatrist appointments. Clinic list size affects costs per patient.


CONCLUSIONS
Multidisciplinary team delivery may reduce use of other services. Although multidisciplinary team delivery is regarded as best practice, sole nurses can effectively provide clozapine services and may be warranted in areas of low population density.
School of Economics, University of Surrey, Guildford, Surrey, UK.
Heather
H
Gage
Hannah
H
Family
Fenella
F
Murphy
Peter
P
Williams
Jane
J
Sutton
Denise
D
Taylor
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use*; D003024:Clozapine / Q000191:economics / Q000627:therapeutic use*; D003151:Community Health Centers / Q000191:economics; D003152:Community Health Nursing / Q000191:economics / Q000458:organization & administration; D003156:Community Mental Health Services / Q000191:economics / Q000458:organization & administration; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010348:Patient Care Team; D011787:Quality of Health Care; D012559:Schizophrenia / Q000188:drug therapy / Q000191:economics / Q000451:nursing*; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
D014150:Antipsychotic Agents; D003024:Clozapine
clozapine; community care; costs; multidisciplinary team; nurse-led; nurses; nursing; outcomes