Clozapine in community practice: a 3-year follow-up study in the Australian Capital Territory

Objective: This paper aims to present the first data on the long-term use o f clozapine in an entire cohort of patients encountered in a community, the Australian Capital Territory. It examines the clinical and financial outco mes 3 years after the prescription of clozapine to a cohort of 37 patients. Method: Experience during the 2 years before clozapine was prescribed was c ompared with experience in the following 3 years on the basis of a retrospe ctive review of official records. Data included hospital and hostel bed use and an estimate of treatment costs. In addition, changes in living circums tances and employment status were assessed and treating psychiatrists repor ted the presence of side effects and their impressions of clinical change s ince clozapine was prescribed. Results: Compared with the preclozapine period, there were significant redu ctions postclozapine in hospital admissions (year 3) and hospital bed-days (year 2) by the total cohort and in hospital bed-days and hospital expendit ure for those patients (n = 25) who remained on clozapine (years 2 and 3). There was no significant increase or decrease postclozapine in the estimate d combined cost of treatment attributable to bed use (hospital or hostel), clozapine tablets, blood monitoring, and the employment of a Clozapine Coor dinator. Clinically, all patients who stayed on clozapine were reported to be moderately or markedly improved. Five of nine patients who were not taki ng clozapine at study's end were unimproved or deteriorated. Conclusions: The findings of significant clinical improvement without evide nce of increased cost lend support for the selective use of clozapine in co mmunity practice.