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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

Improving clozapine use: evidence-based strategies for system change

Improving clozapine utilization: evidence-based strategies that drive systems change

Clozapine underuse is not merely a prescribing issue but an access issue, and improvement requires context-specific strategies for system change that go beyond clinician education.

The talk examines why clozapine, which remains the most effective treatment for treatment-resistant schizophrenia, is underused and how this can be changed. Current data highlight that the problem is not simply one of prescribing but of access: in the United States, clozapine was available at 58% of mental health facilities that prescribed antipsychotics overall, and at 64% of those with a dedicated program for serious mental illness. A systematic review has identified three core strategies: dedicated clozapine clinics, simplified blood monitoring, and prescriber education; implementation, however, is highly context-dependent. Studies from the US Veterans Health Administration show that centers with high utilization have engaged leadership, structured monitoring records, collaboration with pharmacy services, involvement of healthcare professionals outside psychiatry, and local champions. Variation in staffing, services, and patient volume even among clozapine clinics indicates that simply establishing a clinic does not guarantee scalability. Audit and feedback, national or statewide educational initiatives, expert consultation, decision support systems, family support, and ECHO-based programs have shown variable effects, with increased knowledge not always translating into prescribing. Emerging models, such as centers of excellence, remote treatment initiation, remote monitoring, and identification of eligible patients through electronic health records, appear promising. The talk concludes that sustainable improvement requires aligning incentives across patients, clinicians, teams, and systems—including reimbursement, protected time, pharmacy and nursing support, measurement, feedback, and leadership commitment—while addressing deterrents such as unclear responsibility for monitoring, fragmentation between inpatient and outpatient services, limited training, liability concerns, and logistical burdens.

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