Antipsychotic prescribing practices for outpatients with schizophrenia and reasons for non-clozapine treatment - Data from a Danish quality assessment audit

Figures & data

Table 1. Characteristics of antipsychotic prescribing for outpatients with schizophrenia.

Population characteristics	Psych.East, Total^a, N = 668
Demographics
Men	404 (60.5)
Age	41.0 (27.0–56.0)
High needs status^b	163 (24.4)
Treatment
No AP	51 (7.6)
AP monotherapy (APM)	330 (49.4)
AP polytherapy (APP)	287 (43.0)
Regular APP^c	204 (71.1)
2-drug treatment	249 (86.8)
3-drug treatment	35 (12.2)
4-drug treatment	3 (1.0)
LAI treatment^d	160 (24.0)
LAI as part of APP	87 (54.4)
Clozapine treatment	131 (19.6)
Most frequently prescribed AP for regular use	Olanzapine 167 (25.0)
Most frequently prescribed oral AP for regular use	Olanzapine 150 (22.5)
Most frequently prescribed LAI AP	Paliperidone 57 (8.5)
Most frequently prescribed prn AP^e	Quetiapine 83 (12.4)

Distribution of patients with schizophrenia and an outpatients affiliation with the Mental Health Services East (Psych.East, Total) by demographics and type of prescribed antipsychotic (AP) treatment.

^a Values are shown as medians and interquartile ranges (Mdn (Q1-Q3)) or as numbers and proportions in per cent (N (%)) as applicable.

^b The proportion of patients with status of ‘High-needs’ community sample, defined as patients with a local outpatient affiliation with day-hospital or an institutional residence.

^c Regular AP polytherapy = the total number of different, regularly prescribed APs ≥ 2; regular being defined as planned daily consumption or regular injection.

^d LAI: Long-acting injectable.

^e prn AP: antipsychotic prescribed ‘as needed’.

Table 2. Subgroup characteristics of antipsychotic prescribing for outpatients with schizophrenia, divided by clozapine/non-clozapine treatment.

Population characteristics according to AP treatment group	Non-clozapine^a, N = 537	Clozapine^a, N = 131
All groups
Men	304 (56.6)	89 (67.9)
Age	36.0 (26.0–54.0)*	52.0 (40.5–60.5)
High needs^b	118 (22.0)*	45 (34.4)
No AP therapy	51 (9.5)	0
Men	29 (56.9)
Age	27.0 (24.0-31.5)
High needs^b	2 (3.9)
AP monotherapy (APM)	280 (52.1)	50 (38.2)
Men	199 (71.1)	20 (40.0)
Age	39.0 (26.0–59.5)*	55.0 (42.0–65.5)
High needs^b	72 (25.7)	14 (28.0)
In LAI^c treatment	73 (26.1)	0
Most frequently prescribed AP for APM	Olanzapine 87 (31.1)	Clozapine 50 (100)
AP polytherapy (APP)	206 (38.4)*	81 (61.8)
Men	105 (51.0)	51 (63.0)
Age	39.0 (26.0-55.0)*	50.0 (38.0-57.0)
High needs^b	44 (21.4)*	31 (38.3)
2-drug treatment	182 (88.4)	67 (82.7)
3-drug treatment	22 (10.7)	13 (16.1)
4-drug treatment	2 (1.0)	1 (1.2)
In LAI^c treatment	82 (39.8)	5 (7.5)
In regular APP treatment^d	137 (66.5)	67 (82.7)
Most frequently prescribed non-clozapine AP for regular^d APP treatment	Aripiprazole 70 (51.1)	Aripiprazole 13 (19.4)
		Quetiapine 13 (19.4)
		Olanzapine 13 (19.4)
Most frequently prescribed prn^e AP	Quetiapine 71 (34.5)	Quetiapine 12 (14.8)
		Chlorprothixene 12 (14.8)
Patients with naïve clozapine initiation within 5 years	5 (2.4)	20 (15.3)^f
Number of adequately^g trialled APs prior to clozapine initiation	6.0 (3.0-6.0)	4.0 (3.0-5.0)
Age at naïve clozapine initiation	30.0 (25.0-40.0)	25.0 (23.0-32.3)

Distribution of the 668 patients with schizophrenia (DF20.0-20.9) and an outpatient affiliation with the Mental Health Services East (Psych.East, Total) by type of prescribed antipsychotic (AP) (clozapine, non-clozapine) and AP treatment group (NAP = 0, 1, >1).

^a Values are shown as medians and interquartile ranges (Mdn (Q1-Q3)) or as numbers and proportions in per cent (N (%)) as applicable; tested differences between groups are marked with cursive and bold text. Differences are tested with the Mann-Whitney U test for continuous data and with the Chi-square test for discrete data. Significant differences (p < .05) are marked with an asterisk*.

^b Status as of ‘High-needs’ community sample = patients with a local outpatient affiliation with day-hospital or institutional residence.

^c LAI: Long-acting injectable.

^d Regular APP = total number of regularly prescribed APs ≥ 2; regular being defined as planned daily consumption or regular injection.

^e prn AP: antipsychotic prescribed ‘as needed’.

^f Proportion of clozapine patients in total (n = 131).

^g Adequately trialled being defined as duration ≥ 6 weeks for oral prescriptions (3 months for LAI prescriptions) at ≥ min. effective dose according to the manufacturer’s summary of product characteristics.

Table 3. Chart-documented reasons as to why patients are not receiving treatment with clozapine.

Case No.	Reasons for clozapine discontinuation	Supplementary reasons	Reasons for clozapine refusal	Reasons for clozapine non-candidacy
1	Insufficient response
2	Drug incompliance	Drug incompliance, Monitoring
3	Side effects, Somatic issues	Somatic issues	Unspecified reason
4	Side effects
5	Drug incompliance, Side effects
6	Side effects
7	Side effects, Stable condition
8	Insufficient response
9	Drug incompliance, Psychosis	Monitoring
10	Side effects
11	Side effects, Insufficient response
12	Side effects, Insufficient response
13	Drug incompliance, Side effects		Side effects
14			Monitoring
15			Monitoring, Psychosis
16			Monitoring, Responsibility with clozapine
17		Monitoring	Monitoring, Side effects
18			Monitoring
19			Hospitalisation
20			Side effects
21				Monitoring
22				Monitoring
23				Monitoring, Unwillingness to change medicines
24				Drug incompliance
25				Monitoring
26				Monitoring
27				Monitoring
28				Monitoring, Drug incompliance
Total	Side effects (9/13 cases); insufficient response (4/13 cases); drug incompliance (4/13 cases); stable condition (1/13 cases); psychosis (1/13 cases); somatic issues (1/13 cases).	Expected monitoring issues (3/4 cases); Expected drug incompliance (1/4 cases); somatic issues (1/4 cases).	Monitoring requirements (5/9 cases); side effects (3/9 cases); need for hospitalisation (1/9 cases); unspecified reason (1/9 cases); psychosis (1/9 cases), responsibility with clozapine management.	Expected monitoring issues (7/8 cases); expected drug incompliance (2/8 cases); unwillingness to change medicines (1/8 cases).

Distribution of case-specific reasons for non-clozapine treatment according to category of journalised reason(s).

Data availability statement

Due to the nature of this audit, participants of the study did not agree for their data to be shared publicly, hence supporting data is not available.