Underprescribing of Clozapine and Unexplained Variation in Use Across Hospitals and Regions in the Canadian Province of Québec
Clinical guidelines recommend a trial of clozapine for schizophrenia patients who are refractory to other antipsychotics; its benefits for this population, including a reduction in suicide rates, have been documented in numerous studies. This paper uses Québec government administrative data (RAMQ and Med-Echo) to show that, in 2004, fewer than 7% of people with schizophrenia in Québec were receiving clozapine. A rate of 12% would be considered closer to optimal. Moreover, rates of clozapine prescribing vary greatly across hospitals, with 8% of 61 hospitals in the province showing no patients at all on clozapine. It is doubtful if the situation has changed much since then. Several specific measures, including increasing access to community-based teams such as those following the Assertive Community Treatment model (which facilitate the regular blood monitoring required with clozapine) and the setting up of clozapine clinics in each hospital, and of a provincial clozapine resource center such as one that used to exist in British Columbia, would likely help to increase access to this medication for patients who would benefit from it.
Please click here to read/download full paper.
Dr. Eric Latimer is Associate Professor in the Department of Psychiatry and Associate Member of the Department of Epidemiology, Biostatistics and Occupational Health at McGill University. A health economist, his research interests focus on community-based supports for people with severe mental illness, including assertive community treatment and supported employment.
Dr. Latimer contributes economic evaluations of various interventions for people with mental illness. He has also conducted research on the use of antipsychotic and concomitant medications in Québec. Currently, he is lead investigator for the Montreal site of the $110 million Chez Soi / At Home research and demonstration study on homelessness and mental illness, which is testing the Housing First approach using nine concurrent trials in five Canadian cities. He is a member of the recently-established permanent scientific committee of the Institut National d'Excellence en Santé et Services Sociaux, he holds the Bombardier Fellowship in the Quality of Mental Health Care, and is also a fellow of CIRANO.