EFFECTS OF STRINGENT CRITERIA ON ELIGIBILITY FOR CLOZAPINE AMONG PUBLIC MENTAL-HEALTH CLIENTS

Objective: This study estimated rates of eligibility for treatment wit h clozapine among clients in a public mental health system using crite ria with various degrees of restrictiveness. Methods: A stratified, ra ndom cluster sample of 293 clients was selected from among all clients with schizophrenic disorders known to the mental health system of the city and county of San Francisco during 1991. Data on variables assoc iated with eligibility for clozapine were abstracted from clinical rec ords, and eligibility was estimated using broad and stringent criteria . Results: An estimated 42.9 percent of the clients were eligible for clozapine using broad eligibility criteria that included a diagnosis o f schizophrenia or schizoaffective disorder, two previous neuroleptic trials of at least 600 mg per day chlorpromazine equivalents for at le ast four weeks or tardive dyskinesia, Global Assessment of Functioning score less than 61, and no contraindications. Eliminating eligibility due to tardive dyskinesia alone, excluding persons with schizoaffecti ve disorder, requiring six-week medication trials, and requiring three adequate medication trials instead of two resulted in substantial red uctions in the rate of eligibility. Conclusions: Varying interpretatio ns of the criteria for clozapine treatment listed in the medication pa ckage insert dramatically affect patients' eligibility for clozapine. Mental health agencies should endeavor to maintain a balance between r estricting use of clozapine due to cost and providing it to the full s pectrum of patients who might benefit from the medication.