Comparison of sole nurse and team-delivered community clozapine services for people with treatment-resistant schizophrenia

Aim. To compare sole nurse and doctor-led multidisciplinary team delivery of
community clozapine services for people with treatment-resistant schizophrenia.
Background. Around 20% of people with schizophrenia are treatment resistant
and fail to respond to front line medications. Clozapine, a second-line treatment,
has potentially serious side effects requiring regular monitoring. Different models
of community clozapine services are emerging in the British National Health
Service, but there is little evidence about which is best.
Design. Questionnaire survey of service users.
Methods. All patients on the lists of seven clozapine clinics (four sole nurse, three
multidisciplinary team) in one trust were invited to participate, 2009–2010.
Forward stepwise regression was used to investigate associations between patient
well-being, functioning, self-efficacy and satisfaction, and clinic model attended,
controlling for socio-demographic and health characteristics and processes of
care. Use (and costs) of other health and social services accessed was compared
between models.
Results. Sixty-six service users (35% participation rate) responded. Well-being
and functioning were associated with patient characteristics and processes of care,
not clinic model. Patients managed by sole nurses reported, over 3 months: more
community psychiatric nurse visits and hospital psychiatrist appointments. Clinic
list size affects costs per patient.
Conclusions. Multidisciplinary team delivery may reduce use of other services.
Although multidisciplinary team delivery is regarded as best practice, sole nurses
can effectively provide clozapine services and may be warranted in areas of low
population density.