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Differences between physicians' and nurse practitioners' viewpoints on reasons for clozapine underprescription.

  • Okhuijsen-Pfeifer, Cynthia1
  • Cohen, Dan2, 3
  • Bogers, Jan P A M3, 4
  • de Vos, Cato M H1
  • Huijsman, Elianne A H1
  • Kahn, René S1, 5
  • Luykx, Jurjen J1, 6, 7
  • 1 Department of psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. , (Netherlands)
  • 2 MHO GGZ-NHN, Heerhugowaard, The Netherlands. , (Netherlands)
  • 3 Dutch Clozapine Collaboration Group, Castricum, The Netherlands. , (Netherlands)
  • 4 MHO Rivierduinen, High Care Clinics, Oegstgeest, The Netherlands. , (Netherlands)
  • 5 Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, New York.
  • 6 Department of translational neuroscience, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. , (Netherlands)
  • 7 GGNet Mental Health, Apeldoorn, The Netherlands. , (Netherlands)
Published Article
Brain and behavior
Publication Date
Jul 01, 2019
DOI: 10.1002/brb3.1318
PMID: 31144470


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. 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. 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. 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. © 2019 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

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