Comparison of sole nurse and team-delivered community clozapine services for people with treatment-resistant schizophrenia

Gage, H, Family, H, Murphy, F, Williams, P, Sutton, J and Taylor, D (2015) Comparison of sole nurse and team-delivered community clozapine services for people with treatment-resistant schizophrenia JOURNAL OF ADVANCED NURSING, 71 (3). pp. 547-558.

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Abstract

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.

Item Type:	Article
Subjects :	Economics
Divisions :	Faculty of Arts and Social Sciences > School of Economics
Authors :	Authors Email ORCID Gage, H UNSPECIFIED UNSPECIFIED Family, H UNSPECIFIED UNSPECIFIED Murphy, F UNSPECIFIED UNSPECIFIED Williams, P UNSPECIFIED UNSPECIFIED Sutton, J UNSPECIFIED UNSPECIFIED Taylor, D UNSPECIFIED UNSPECIFIED
Date :	1 March 2015
Identification Number :	https://doi.org/10.1111/jan.12527
Copyright Disclaimer :	This is the peer reviewed version of the following article: Gage H., Family H., Murphy F., Williams P., Sutton J. & Taylor D. (2015) Comparison of sole nurse and team-delivered community clozapine services for people with treatment-resistant schizophrenia. Journal of Advanced Nursing 71(3), 547–558. doi: 10.1111/jan.12527, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jan.12527/abstract. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Uncontrolled Keywords :	Science & Technology, Life Sciences & Biomedicine, Nursing, clozapine, community care, costs, multidisciplinary team, nurse-led, nurses, nursing, outcomes, COSTS, CARE
Related URLs :	Author
Depositing User :	Symplectic Elements
Date Deposited :	12 Aug 2016 16:06
Last Modified :	23 Aug 2016 07:51
URI:	http://epubs.surrey.ac.uk/id/eprint/811700

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