{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T16:54:48Z","timestamp":1778864088022,"version":"3.51.4"},"reference-count":5,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,5,29]],"date-time":"2019-05-29T00:00:00Z","timestamp":1559088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Clozapine (CLZ) is the only proven effective therapy for treatment\u2010resistant schizophrenia, but it is underutilized across the globe. Previous findings suggest a lack of experience with CLZ prescription and concerns about CLZ's pharmacological characteristics are the prime reasons for CLZ underutilization. To our knowledge, it is currently unknown whether the reasons for underutilization and suggested solutions differ between physicians and nurse practitioners. Such differences are important as nurse practitioners are becoming increasingly involved in prescribing CLZ.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>To examine to what degree physicians and nurse practitioners differ with regard to their take on reasons for CLZ underutilization and suggested solutions, an online questionnaire was distributed to physicians and nurse practitioners. The primary outcome was to compare the <jats:italic>patient<\/jats:italic>\u2010related and <jats:italic>prescriber<\/jats:italic>\u2010related reasons for CLZ underprescription between physicians and nurse practitioners, while secondary outcome measures included the potential solutions to prevent this underprescription.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Physicians (<jats:italic>N<\/jats:italic>\u00a0=\u00a0112) and nurse practitioners (<jats:italic>N<\/jats:italic>\u00a0=\u00a041) agreed that the two most common reasons for underprescription (<jats:italic>patient<\/jats:italic>\u2010related and <jats:italic>prescriber<\/jats:italic>\u2010related) were refusal to undergo regular blood tests and side\u2010effect concerns. They also agreed that the third most common <jats:italic>prescriber<\/jats:italic>\u2010related reason was medical complications. Physicians rated patients' unwillingness to switch medication as the third most common reason for CLZ underprescription, whereas nurse practitioners rated refusal to undergo baseline bloodtests as the third most common reason. The solutions to reduce underprescription largely corresponded between both groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We conclude that slight differences exist between physicians' and nurse practitioners' viewpoints on patient\u2010related and prescriber\u2010related reasons for CLZ underprescription. Future research projects should involve patients to elucidate whether the patient\u2010related factors put forward by prescribers align with the patients' opinions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/brb3.1318","type":"journal-article","created":{"date-parts":[[2019,5,30]],"date-time":"2019-05-30T04:10:05Z","timestamp":1559189405000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Differences between physicians' and nurse practitioners' viewpoints on reasons for clozapine underprescription"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9649-3879","authenticated-orcid":false,"given":"Cynthia","family":"Okhuijsen\u2010Pfeifer","sequence":"first","affiliation":[{"name":"Department of psychiatry Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Cohen","sequence":"additional","affiliation":[{"name":"MHO GGZ\u2010NHN Heerhugowaard The Netherlands"},{"name":"Dutch Clozapine Collaboration Group Castricum The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan P. A. M.","family":"Bogers","sequence":"additional","affiliation":[{"name":"Dutch Clozapine Collaboration Group Castricum The Netherlands"},{"name":"MHO Rivierduinen, High Care Clinics Oegstgeest The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cato M. H.","family":"de Vos","sequence":"additional","affiliation":[{"name":"Department of psychiatry Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elianne A. H.","family":"Huijsman","sequence":"additional","affiliation":[{"name":"Department of psychiatry Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ren\u00e9 S.","family":"Kahn","sequence":"additional","affiliation":[{"name":"Department of psychiatry Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University Utrecht The Netherlands"},{"name":"Department of Psychiatry Icahn School of Medicine at Mount Sinai New York City New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jurjen J.","family":"Luykx","sequence":"additional","affiliation":[{"name":"Department of psychiatry Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University Utrecht The Netherlands"},{"name":"Department of translational neuroscience University Medical Center Utrecht, Utrecht University Utrecht The Netherlands"},{"name":"GGNet Mental Health Apeldoorn The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,5,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12193"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.111.105833"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269881108100320"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12954"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2018.05.046"}],"container-title":["Brain and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbrb3.1318","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.1318","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/brb3.1318","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.1318","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T20:40:55Z","timestamp":1694292055000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/brb3.1318"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,29]]},"references-count":5,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1002\/brb3.1318"],"URL":"https:\/\/doi.org\/10.1002\/brb3.1318","archive":["Portico"],"relation":{},"ISSN":["2162-3279","2162-3279"],"issn-type":[{"value":"2162-3279","type":"print"},{"value":"2162-3279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,29]]},"assertion":[{"value":"2019-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e01318"}}