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Postcode prescribing in psychiatry

Clozapine in an English county

School of Psychiatry & Behavioural Sciences, Department of Psychiatry, Withington Hospital, West Didsbury, Manchester M20 8LR

AIMS AND METHOD

We aimed to examine variations in clozapine prescribing in all 12 NHS trusts with catchment area mental health services in one English county, over a 2-year period. We tested a series of hypotheses to explain the variation in prescribing of clozapine.

RESULTS

A 34-fold variation between trusts in rates of clozapine provision was found after adjusting for measures of local population need. This variation did not change over the 2 years examined. It was not explained by differences in resource level.

CLINICAL IMPLICATIONS

The evidence base is strong for the effectiveness and likely cost-effectiveness of clozapine in severe schizophrenia. Our data indicate that variations in evidence-based clinical practice at the provider level led to the wide variation in clozapine prescribing.

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