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Comparison of sole nurse and team‐delivered community clozapine services for people with treatment‐resistant schizophrenia
Author(s) -
Gage Heather,
Family Hannah,
Murphy Fenella,
Williams Peter,
Sutton Jane,
Taylor Denise
Publication year - 2015
Publication title -
journal of advanced nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.948
H-Index - 155
eISSN - 1365-2648
pISSN - 0309-2402
DOI - 10.1111/jan.12527
Subject(s) - multidisciplinary approach , medicine , clozapine , nursing , patient satisfaction , schizophrenia (object oriented programming) , multidisciplinary team , population , service delivery framework , mental health , service (business) , health care , psychiatry , family medicine , social science , environmental health , economy , sociology , economic growth , economics
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.