WORKSHOP: Integrating Quality Guidelines into Systemic Schizophrenia Treatment: The Ottawa Model of Care
Presenting Author(s): Dr. David Attwood, MD, FRCPC
Date and time: 23 Mar 2024 from 13:00 to 13:30
Location: Hawthorn A
Learning Objectives
1. Discuss the role of quality standard-based treatment(s)for persons with schizophrenia;
2. Navigate the gap between knowledge and practice in the treatment refractory schizophrenia; and
3. Provide a high level overview of the Ottawa Model for Schizophrenia care.
Literature References
1. Sch Guidelines: https://journals.sagepub.com/doi/epub/10.1177/0706743717719897
2. Barriers to clozapine use: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327301/
3. Underutilization of clozapine: https://meridian.allenpress.com/mhc/article/5/2/63/38113/Clozapine-underutilization-in-treatment-resistant
4. Adherence: https://pubmed.ncbi.nlm.nih.gov/32627168/
5. HQO: https://www.hqontario.ca/Portals/0/documents/evidence/quality-standards/qs-schizophrenia-care-in-hospitals-quality-standard-en.pdf
Abstract
As health care resources respond to chronic stress tests, the desire to incorporate quality-based interventions are a necessity. With the move towards measurement-based outcomes, mental health providers and agencies will need to demonstrate that they are implementing best possible evidence-based practices to build, maintain or potentially acquire funding and support. The Health Quality Ontario Standards for Schizophrenia, as well as every contemporary schizophrenia treatment guideline, are unambiguous on their recommendations on the use of clozapine, especially for treatment refractory schizophrenia, which represents 30 – 40 % of persons affected by the illness.
Clozapine is one of only a few agents associated with suicide reduction, demonstrated to have a positive impact on quality and quantity of life for persons with schizophrenia, and is the only agent with differential efficacy against treatment refractory schizophrenia. Yet despite these established observations, the underutilization of clozapine remains a conundrum of contemporary psychiatric practice.
The reasons are multifactorial, including both prescriber and patient factors, but physicians who prescribe clozapine report a high degree of satisfaction with the practice, and despite concerns that patients will refuse clozapine, the actual evidence is that patients prefer care that adheres to the evidence-base.
At the beginning of the pandemic, The Royal Ottawa Schizophrenia Program recognized the need for a severe pivot that funneled all clozapine related services through a single pathway, basically a one way corridor through the hospital. While not necessarily patient centered, it appears that not a single dose of clozapine was missed due to systemic or organizational restrictions.Learning from that experience, and dovetailing on the Ottawa Regional Psychosis Clinic, we have elaborated a model of care using evidence-based standards that embeds clozapine resources into the continuum of care. This includes multidisciplinary care team training and expertise, integration of point of care testing and real-time interaction with the clozapine registry, the potential for therapeutic drug monitoring, and seamless access to expert clozapine care across the lifespan, from first episode to end of life care. The goal of this symposium is to provide a high level overview of the Ottawa Model for Schizophrenia Care across the lifespan, to stimulate discussion and solution finding, and to advocate for systemic access to clozapine care that is embedded into mental health structures, ensuring stigma-free access to quality standard based treatment(s) for persons with schizophrenia.