Robert O. Cotes, M.D. Assistant Professor Medical Director, - PowerPoint PPT Presentation

Robert O. Cotes, M.D. Assistant Professor Medical Director, Inpatient Psychiatry at Grady Memorial Hospital Director, PSTAR Clinic at Grady Memorial Hospital Associate Residency Training Director Department of Psychiatry and Behavioral Sciences Emory University School of Medicine

 Dr. Cotes has accepted research funding, consultation fees and/or honorariums from Janssen and Ostuka Pharmaceuticals.

 Introduction  Prescriber Perspectives  Georgia  AACP national sample  Consumer Perspectives

Stroup, T. S., Gerhard, T., Crystal, S., Huang, C., & Olfson, M. (2014). Geographic and clinical variation in clozapine use in the United States. Psychiatr Serv, 65 (2), 186-192.

 25 item survey  Georgia Psychiatric Physicians Association (GPPA)  Distributed at Winter Meeting 2015  98 surveys completed  American Association of Community Psychiatrists (AACP)  Distributed in three email waves from 2015-2016  Response rate ~10%  57 surveys completed

% Female 46 46 Median Years Post Training 23 17 % Expert in Schizophrenia 19 49 % Private Practice 50 12 % Majority Clients Uninsured 18 31 % Majority Clients Psychotic Disorder 17 54

% Prescribed clozapine lifetime 81 100 % Prescribed clozapine within 1 month 37 89

48 47 % Respondents 37 GPPA AACP 19 11 11 9 5 3 0 0 1 TO 5 6 TO 10 11 TO 15 >20

“Very comfortable” 23% 75% “Somewhat comfortable” 33% 19% “Neutral” 9% 5% “Somewhat uncomfortable” 21% 0% “Very uncomfortable” 13% 0%

9 EFFICACY 8 AACP GPPA 7 SAFETY 6 0 1 2 3 4 5 6 7 8 9 10 LEAST MOST

60 % Respondents GPPA 34 32 AACP 31 30 7 3 3 AFTER 1 FAILURE AFTER 2 FAILURES AFTER 3 FAILURES AFTER MORE THAN 3 FAILURES

43 43 40 % Respondents 26 GPPA AACP 20 13 11 3 AFTER 1 FAILURE AFTER 2 FAILURES AFTER 3 FAILURES AFTER MORE THAN 3 FAILURES

% Specialized training in residency 25 14 % Use plasma clozapine levels 31 64 % Use myocarditis screening protocol 20 9 % On site laboratory 42 48 Modal highest dose reported (mg) 600 900

53 % Respondents GPPA AACP 21 YES

 Survey administered to outpatients on clozapine > 1 month  30 questions  59 surveys completed from 2015-2016

Characteristic % Female 31 Median Age 44 African American 70 Smoke Cigarettes 41 On Antipsychotic Polypharmacy 7

41 39 % Respondents 10 7 2 VERY NEGATIVE NEGATIVE NEUTRAL POSITIVE VERY POSITIVE

33 % Respondents 16 13 7 < 1 YEAR 1-5 YEARS 5-10 YEARS >10 YEARS

8.5 SAFETY 7 Consumers AACP GPPA 6.1 0 1 2 3 4 5 6 7 8 9 LEAST MOST

8.4 EFFICACY 9 Consumers AACP GPPA 8.4 0 1 2 3 4 5 6 7 8 9 10 LEAST MOST

 Differences exist between groups of prescribers  AACP may be in a unique position to advocate for safe clozapine use  Consumers and prescribers agree clozapine is a safe and effective treatment for schizophrenia  More specialized training opportunities in residency are needed for clozapine

 David Goldsmith  Sarah Kopelovich  Umair Janjua  Jonathon Widener  Barbara Hartsfield  Derek Novacek  Shama Pawjwani  Jungjin Kim