Robert O. Cotes, M.D. Assistant Professor Medical Director, - - PowerPoint PPT Presentation

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Robert O. Cotes, M.D. Assistant Professor Medical Director, - - PowerPoint PPT Presentation

Nov 26, 2022 170 likes •412 views

Robert O. Cotes, M.D. Assistant Professor Medical Director, Inpatient Psychiatry at Grady Memorial Hospital Director, PSTAR Clinic at Grady Memorial Hospital Associate Residency Training Director Department of Psychiatry and Behavioral Sciences

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Robert O. Cotes, M.D. Assistant Professor Medical Director, Inpatient Psychiatry at Grady Memorial Hospital Director, PSTAR Clinic at Grady Memorial Hospital Associate Residency Training Director Department of Psychiatry and Behavioral Sciences Emory University School of Medicine

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  • Dr. Cotes has accepted research funding, consultation fees

and/or honorariums from Janssen and Ostuka Pharmaceuticals.

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  • Introduction
  • Prescriber Perspectives
  • Georgia
  • AACP national sample
  • Consumer Perspectives
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Stroup, T. S., Gerhard, T., Crystal, S., Huang, C., & Olfson, M. (2014). Geographic and clinical variation in clozapine use in the United States. Psychiatr Serv, 65(2), 186-192.

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  • 25 item survey
  • Georgia Psychiatric Physicians Association (GPPA)
  • Distributed at Winter Meeting 2015
  • 98 surveys completed
  • American Association of Community Psychiatrists (AACP)
  • Distributed in three email waves from 2015-2016
  • Response rate ~10%
  • 57 surveys completed
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% Female 46 46 Median Years Post Training 23 17 % Expert in Schizophrenia 19 49 % Private Practice 50 12 % Majority Clients Uninsured 18 31 % Majority Clients Psychotic Disorder 17 54

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% Prescribed clozapine lifetime 81 100 % Prescribed clozapine within 1 month 37 89

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48 37 5 3 11 47 9 11 19 1 TO 5 6 TO 10 11 TO 15 >20 % Respondents GPPA AACP

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“Very comfortable” 23% 75% “Somewhat comfortable” 33% 19% “Neutral” 9% 5% “Somewhat uncomfortable” 21% 0% “Very uncomfortable” 13% 0%

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6 8 7 9 1 2 3 4 5 6 7 8 9 10 SAFETY EFFICACY LEAST MOST AACP GPPA

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3 31 34 32 3 60 30 7 AFTER 1 FAILURE AFTER 2 FAILURES AFTER 3 FAILURES AFTER MORE THAN 3 FAILURES % Respondents GPPA AACP

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26 40 20 13 43 43 11 3 AFTER 1 FAILURE AFTER 2 FAILURES AFTER 3 FAILURES AFTER MORE THAN 3 FAILURES % Respondents GPPA AACP

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% Specialized training in residency 25 14 % Use plasma clozapine levels 31 64 % Use myocarditis screening protocol 20 9 % On site laboratory 42 48 Modal highest dose reported (mg) 600 900

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53 21 YES % Respondents GPPA AACP

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  • Survey administered to
  • utpatients on clozapine

> 1 month

  • 30 questions
  • 59 surveys completed

from 2015-2016

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Characteristic % Female 31 Median Age 44 African American 70 Smoke Cigarettes 41 On Antipsychotic Polypharmacy 7

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2 7 10 41 39 VERY NEGATIVE NEGATIVE NEUTRAL POSITIVE VERY POSITIVE % Respondents

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7 16 33 13 < 1 YEAR 1-5 YEARS 5-10 YEARS >10 YEARS % Respondents

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6.1 7

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1 2 3 4 5 6 7 8 9 SAFETY LEAST MOST Consumers AACP GPPA

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8.4 9

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1 2 3 4 5 6 7 8 9 10 EFFICACY LEAST MOST Consumers AACP GPPA

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  • Differences exist between groups of prescribers
  • AACP may be in a unique position to advocate for safe

clozapine use

  • Consumers and prescribers agree clozapine is a safe and

effective treatment for schizophrenia

  • More specialized training opportunities in residency are

needed for clozapine

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  • David Goldsmith
  • Sarah Kopelovich
  • Umair Janjua
  • Jonathon Widener
  • Barbara Hartsfield
  • Derek Novacek
  • Shama Pawjwani
  • Jungjin Kim
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