title: An Initiative to Improve Clozapine Prescribing in New York State.
abstract: Clozapine remains the only medication approved for treatment-resistant schizophrenia. But underuse is the norm. In 2010, the New York State Office of Mental Health began a multifaceted initiative to promote the evidence-based use of clozapine. From 2009 to 2013, in the absence of a well-funded pharmaceutical marketing campaign, the proportion of new clozapine trials among all new outpatient antipsychotic trials increased 40% among adult New York Medicaid recipients with a diagnosis of schizophrenia. The largest gains occurred in state-operated clinics. New York's experience demonstrates the feasibility of making clozapine more accessible to patients who stand to benefit most.
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Jay
authors.initials: J
authors.lastname: Carruthers
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Marleen
authors.initials: M
authors.lastname: Radigan
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Erlich
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Gyojeong
authors.initials: G
authors.lastname: Gu
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Eric Y
authors.initials: EY
authors.lastname: Frimpong
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Essock
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Enrico G
authors.initials: EG
authors.lastname: Castillo
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Miller
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: Lloyd I
authors.initials: LI
authors.lastname: Sederer
authors.affiliation: Dr. Carruthers, Dr. Radigan, Dr. Erlich, Mr. Gu, Mr. Wang, Dr. Frimpong, Dr. Miller, and Dr. Sederer are with the New York State Office of Mental Health, Albany (e-mail: jay.carruthers@omh.ny.gov ). Dr. Carruthers is also with the Department of Psychiatry, Albany Medical College, Albany, New York. Dr. Radigan and Dr. Erlich are also with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Essock and Dr. Stroup are affiliated. Dr. Sederer is also with the Mailman School of Public Health, Columbia University, New York City. Dr. Essock and Dr. Stroup are also with the New York State Psychiatric Institute, New York City, where Dr. Olfson is affiliated. Dr. Olfson is also with Columbia University Medical Center, New York City. Dr. Castillo is with the Robert Wood Johnson Foundation Clinical Scholars Program, University of California, Los Angeles. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column.
authors.forename: T Scott
authors.initials: TS
authors.lastname: Stroup
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans; D008484:Medicaid; D009518:New York; D015397:Program Evaluation; D012559:Schizophrenia / Q000188:drug therapy*; D014481:United States
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine