| Title: |
Treating Unmet Needs in Psychiatry (TUNE-UP): targeted service increases out-patient initiations of clozapine |
| Authors: |
Ahmad Khan, Z; Varvari, I; Mancini, V; Zita-Zauchenberger, C; Kantor, S; Fanshawe, JB; Musiiwa, S; Pledge, A; Pearce, B; de La Motte de Broöns de Vauvert, SJGN; Quested, D; Maughan, D; Baskerville-Butler, J; McGuire, P; Howes, OD; Pillinger, T; McCutcheon, RA |
| Publisher Information: |
Cambridge University Press |
| Publication Year: |
2026 |
| Collection: |
Oxford University Research Archive (ORA) |
| Description: |
Background: In the UK, clozapine is the only licensed treatment for treatment-resistant schizophrenia (TRS). However, it is underused because initiation is often limited by the need for in-patient admission, which is costly and unattractive to patients. Community clozapine services may address this. Aims: To describe a targeted out-patient clinic (Treating Unmet Needs in Psychiatry (TUNE-UP)) for TRS management and assess its impact on community clozapine initiation rates. Method: We reviewed clozapine titrations of patients under four community mental health teams from September 2021 to January 2025, recording whether titration occurred as in- or out-patient. The TUNE-UP clozapine clinic operated for 12 months (September 2023 to September 2024). Initiation rates during the TUNE-UP period were compared with those when the service was unavailable, using Poisson regression. Clinical outcomes were assessed using scales including the Positive and Negative Syndrome Scale (PANSS). Results: Fifty-one individuals commenced clozapine during the study period. There was a significant increase in the rates of community initiation in the TUNE-UP period (11.0 per year) compared with those outside of this period (1.71 per year; incidence risk ratio 6.42 [95% CI 2.04–20.2, P = 0.0015]). Patients seen by TUNE-UP showed significant improvements in PANSS (n = 6, median improvement 21.5 [95% CI 7.0–33.0], P = 0.03). Conclusions: A specialist service was associated with a significant increase in community clozapine initiations. This approach offers a strategy to improve TRS treatment in the community. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
https://doi.org/10.1192/bjo.2026.10988 |
| DOI: |
10.1192/bjo.2026.10988 |
| Availability: |
https://doi.org/10.1192/bjo.2026.10988; https://ora.ox.ac.uk/objects/uuid:3b1d164b-507c-4e20-a5a3-e1eaa15ed824 |
| Rights: |
info:eu-repo/semantics/openAccess ; CC Attribution (CC BY) |
| Accession Number: |
edsbas.4BC3DF54 |
| Database: |
BASE |