(60) Optimizing Monitoring Frequency for Clozapine Patients Across the Department of Veterans Affairs Health System

Publication Number: 1105

Background: Clozapine is an effective antipsychotic but has frequent blood monitoring requirements, depending on length of time the patient has been on the medication.

Objectives: 1) To identify patients eligible for reduced monitoring frequency using a national clozapine database, and to update these patients to an extended monitoring interval for which they are eligible.
2) To evaluate the cost-benefits related to automating extending the monitoring frequency.

Methods: All patients that receive clozapine from the Department of Veterans Affairs (VA) must be registered with the VA National Clozapine Coordinating Center (NCCC). A retrospective review and analysis of each patient’s clozapine history was conducted using information from VA databases that collect prescription history, including clozapine as a registered patient. The databases identify patients that may be due for an update in extending monitoring intervals based on the following parameters:
o Active in the NCCC database
o Received any outpatient clozapine prescription in the last 56 days
o No evidence of benign ethnic neutropenia, in hospice, or on chemotherapy
o Registered with the NCCC between 6 and 24 months prior to review date
o Currently receiving 7 or 14 day monitoring

Following identification of patients that were possibly eligible for an extension in their monitoring interval, NCCC staff e-mailed prescribers to notify them of the patient’s eligibility. Patient records were reviewed 6-months after the evaluation to identify if monitoring intervals had been extended.

A cost-benefit analysis will be performed to assess the transition to an automated evaluation and intervention, in place of a manual process.

Results: A total of 133 patients were identified for review. Nineteen (14.3%) patients were identified as eligible for extending the monitoring interval. The monitoring interval for 16 of 19 (84.2%) patients was extended when records were reviewed 6 months later.

Of the patients that were updated to an extended monitoring interval, 10 (62.5%) were updated within 28 days of e-mailing the physician.

Conclusions: Most patients have the correct monitoring interval for clozapine lab monitoring. Though patients would like to be on the longest monitoring intervals, physician discretion is important for the safe administration of clozapine. This review was performed manually, so an automated process may ultimately reduce the cost to the VA.