BARRIERS TO CLOZAPINE USE IN TREATMENT-REFRACTORY POPULATION IN KARACHI, PAKISTAN
Abstract
ABSTRACT
Background & Objective: Following its volatile emergence after the famous 1975 agranulocytosis scare, clozapine remains to be under-prescribed in Pakistan. It has evidently proven to improve prognosis in such patients when initiated at an early stage. However, healthcare barriers and adverse effects continue to haunt psychiatrists to prescribe it more frequently. Although much research targeting clozapine has been done, the factors responsible for the under-prescription of this drug have never been formally elucidated in Pakistan. This study was designed to investigate the causes accountable for serving as barriers in prescribing clozapine in several outpatient departments in Karachi, Pakistan.
Method: A cross-sectional study was conducted over three months (May 2022 to July 2022) using a structured questionnaire from 105 physicians with previous formal training in psychiatry. Statistical analysis was done using the Chi-Square test of association.
Results: Out of 105 doctors offering psychiatric services at various locations, 70% mentioned that they were uncomfortable prescribing clozapine earlier in the course, with its adverse effects profile being the most popular reason for its avoidance by the patients and/or their families. Clozapine's availability and its cost were also common barriers to prescribing clozapine. Most doctors agreed that they would have felt more comfortable if they had had some clozapine training and attended clozapine clinics during their training.
Conclusion: The anticipation of medication nonadherence and monitoring requirements coupled with overestimating the adverse effect profile stems from inadequate experience with the drug Steps should be taken by the graduate medical education at the training hospitals to organize clozapine clinics and offer clozapine training to promote the use of this effective drug to improve the prognosis and function suffering from this debilitating illness.
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