Research carried out at the University of Bath, which evaluated alternative models for the delivery of clozapine services for the treatment and care of patients with schizophrenia, has shown a need to review existing practices.
The study, published by the Pharmacy Practice Research Trust (PPRT), showed that there is scope to review the team configurations needed to deliver community services in a cost-effective manner and to provide opportunities for improving the services provided to patients.
The research was carried out by Dr Denise Taylor and Dr Jane Sutton from the Department of Pharmacy and Pharmacology.
The study looked at different models of care for the delivery of clozapine for people with treatment resistant schizophrenia (TRS) in an NHS Trust in the UK via seven community-based clozapine clinics.
The staffing configuration of these clinics varied across sites with some having nurses, pharmacists or doctors, or a combination of these.
Patients attending clinics where services were delivered by a team of professionals reported better health, wellbeing and self-efficacy than those attending clinics run only by nurses.
However, patients attending nurse-led clinics reported higher satisfaction in some other domains. It was difficult to attribute the specific contribution of pharmacists because when they were present, so were doctors and nurses.
The research also found, from both patient and professional perspectives, that the pharmacists’ role at present is unclear to patients, is underused in the view of some pharmacists and that more responsibilities could be transferred to pharmacists.
Dr Sutton said: “Each of the pharmacists in the study played a different role at the clinic they attended and since there was no clear job or role description for their input, they did the tasks that they felt most comfortable with.
“Regarding their extended role, pharmacists said they would prescribe for side effects but did not want to prescribe for clozapine and one said that this was because they did not want to take the responsibility for prescribing in this area.
“Consultation observations suggested that the healthcare professionals seemed to be largely focused on completing physical examinations and gathering information relevant to their regular clinic tasks.
“These physical checks were, of course, essential, but some patients’ concerns about social or welfare issues were overlooked.”