Fostering the use of clozapine in the severely mentally ill through academic detailing

Abstract

Academic detailing is an educational program in which independent researchers and clinicians evaluate available literature to develop up-to-date, unbiased, evidence-based recommendations for a given therapeutic area. Pharmacists, nurses, and physicians trained as academic detailers then disseminate this information to providers. This is one means to foster the greater use of clozapine in patients with treatment-resistant schizophrenia. The Veterans Health Administration (VHA) Academic Detailing Service meets with mental health providers at each facility to identify barriers and healthcare systems solutions, provide feedback about prescribing and patterns of care, and develop and distribute educational materials to improve veteran health outcomes. Preliminary results include a reduction in polypharmacy antipsychotic use from 17% of patients on antipsychotics to 12.2% of patients (p<0.001). Although there was a numeric increase clozapine new starts in the 5-month interim analysis, the increase was not significant in this analysis. Analysis for 12-month data is underway. The early success of this program demonstrates there may be opportunity for this type of educational intervention in the Veterans Affairs Healthcare System.