Blood Draw Barriers for Treatment with Clozapine and Development of Point-of-Care Monitoring Device.

BACKGROUND Clozapine is the most effective antipsychotic drug for schizophrenia treatment, however it is currently underused. In order to understand the barriers of frequent blood draws for white blood cell counts (WBCs) and clozapine levels, we developed a psychiatrist survey and began and integrative approach of designing a point-of-care device that could eventually have real-time monitoring with immediate results. METHODS We ascertained barriers related to clozapine management and the acceptance of possible solutions by sending an anonymous survey to physicians in psychiatric practice (N=860). In parallel we tested clozapine sensing using a prototype point-of-care monitoring device. RESULTS 255 responses were included in the survey results. The two barriers receiving mean scores with the highest agreement as being a significant barrier were patient nonadherence to blood work and blood work's burden on the patient (out of 28). Among nine solutions, the ability to obtain lab results in the physician's office or pharmacy was top-ranked (mean±sd Likert scale (4.0±1.0)). Physicians responded that a point-of-care device to measure blood levels and WBCs would improve care and increase clozapine use. Residents ranked point-of-care devices higher than older physicians (4.07±0.87 vs. 3.47±1.08, p<0.0001). Also, the prototype device was able to detect CLZ reliably in 1.6, 8.2, and 16.3μg/mL buffered solutions. DISCUSSION Survey results demonstrate the physician's desire for point-of-care monitoring technology, particularly among younger prescribers. Prototype sensor results identify that clozapine can be detected and integrated for future device development. Future development will also include integration of WBCs for a complete detection device.