Clozapine, concomitant medications and consumers: Assessing the accuracy of medication records and the lived experience of people prescribed clozapine under shared care arrangements

Kate Murphy, University, My, Amanda Wheeler
2018
Schizophrenia is a serious long-term mental illness associated with significant morbidity and mortality. Clozapine is the most effective antipsychotic medication for the treatment of schizophrenia, however, due to potentially life-threatening haematological adverse effects, its use is restricted to people who have not responded to an adequate trial of at least two other antipsychotic medications. The high risk of adverse effects, associated mandatory monitoring and prescribing restrictions all
more » ... ean that clozapine consumers often continue to be managed in a secondary care public mental health (MH) service. In people stabilised on maintenance treatment living in the community, a shared care model, involving collaboration between a psychiatrist in secondary care, a general practitioner (GP) and community pharmacy in primary care is a management option. The aim of shared care is to lessen the burden on the consumer and on the secondary care service by allowing the GP to undertake the majority of monitoring and reduce the frequency of secondary care appointments. While this may appear to be an ideal arrangement, discrepancies in medication information at transitions of care from one health service to another are common and contribute to prescribing errors. Where clinicians do not have full medication information there is potential for inappropriate clinical decision-making and the consumer can be exposed to adverse drug events (ADEs), which are defined as any harm occurring during drug therapy. The overall aim of the study was to generate information and form recommendations to optimise communication pathways and access to accurate medication information between and for stakeholders (secondary care, general practice and community pharmacy) and consumers of a clozapine shared care service. The study was designed to assess the completeness and accuracy of consumer medication records held by shared care stakeholders and to describe the experiences of the consumers. This was an exploratory mixed methods study undertaken i [...]
doi:10.25904/1912/162 fatcat:tlbgb3p3yzg45gtlpmv2k77n7q