Differences between physicians' and nurse practitioners' viewpoints on reasons for clozapine underprescription.
INTRODUCTION
Clozapine (CLZ) is the only proven effective therapy for treatment-resistant schizophrenia, but it is underutilized across the globe. Previous findings suggest a lack of experience with CLZ prescription and concerns about CLZ's pharmacological characteristics are the prime reasons for CLZ underutilization. To our knowledge, it is currently unknown whether the reasons for underutilization and suggested solutions differ between physicians and nurse practitioners. Such differences are important as nurse practitioners are becoming increasingly involved in prescribing CLZ.


METHODS
To examine to what degree physicians and nurse practitioners differ with regard to their take on reasons for CLZ underutilization and suggested solutions, an online questionnaire was distributed to physicians and nurse practitioners. The primary outcome was to compare the patient-related and prescriber-related reasons for CLZ underprescription between physicians and nurse practitioners, while secondary outcome measures included the potential solutions to prevent this underprescription.


RESULTS
Physicians (N = 112) and nurse practitioners (N = 41) agreed that the two most common reasons for underprescription (patient-related and prescriber-related) were refusal to undergo regular blood tests and side-effect concerns. They also agreed that the third most common prescriber-related reason was medical complications. Physicians rated patients' unwillingness to switch medication as the third most common reason for CLZ underprescription, whereas nurse practitioners rated refusal to undergo baseline bloodtests as the third most common reason. The solutions to reduce underprescription largely corresponded between both groups.


CONCLUSIONS
We conclude that slight differences exist between physicians' and nurse practitioners' viewpoints on patient-related and prescriber-related reasons for CLZ underprescription. Future research projects should involve patients to elucidate whether the patient-related factors put forward by prescribers align with the patients' opinions.
['Okhuijsen-Pfeifer|Cynthia|C|0000-0002-9649-3879', 'Cohen|Dan|D|', 'Bogers|Jan P A M|JPAM|', 'de Vos|Cato M H|CMH|', 'Huijsman|Elianne A H|EAH|', 'Kahn|René S|RS|', 'Luykx|Jurjen J|JJ|']
D000328:Adult D014150:Antipsychotic Agents D001291:Attitude of Health Personnel D003024:Clozapine D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009722:Nurse Practitioners D010820:Physicians D010818:Practice Patterns, Physicians' D012559:Schizophrenia D011795:Surveys and Questionnaires
nurse practitioners clozapine antipsychotic agents physician's practice patterns schizophrenia spectrum and other psychotic disorders