For those who admit to occasional memory lapses or who may realize that they are inadvertently biasing their antipsychotic agent selection, help may soon be at hand. During a three-part presentation populated by interactive case histories of patients with schizophrenia, clinicians could compare their own therapy selections with those agents suggested by an e-health tool. While there was broad, general agreement between agents selected by clinicians and the e-health tool, there were also some interesting learning points.
The e-health tool is based on the best available evidence from clinical studies and the collective judgement of 11 international experts in schizophrenia
Robin Emsley, of the University of Stellenboch, South Africa, explained how the information and choices contained within the tool had been gathered and assessed. The best available evidence from clinical studies and the collective judgement of 11 international experts in schizophrenia were combined using the RAND/UCLA Appropriateness Method through an iterative process of individual rating rounds and plenary discussions. By this means, the appropriateness of antipsychotic treatment regimens was rated for several patient conditions. Conditions relevant to treatment choice included disease stage, symptoms and any previous treatment responses together with physical comorbidities, likely adherence to therapy and any complicating psychiatric conditions.
In total, 35 antipsychotic monotherapies were judged in 1,107 clinical scenarios. Using algorithms, outcomes for separate conditions were combined to generate treatment recommendations for mutually-exclusive patient profiles. These recommendations were then embedded in the e-health tool. Use of the tool by panel members has helped its validation and an applicability study is ongoing to assess its use in the usual care settings.
A total of 35 antipsychotic monotherapies were judged in 1,107 clinical scenarios
Audience voting and the e-health tool recommendations were compared when four case histories involving recent-onset schizophrenia were presented by Profs John Kane and Christoph Correll, both from New York, USA. Three case histories considered the acute first admission of patients with varied psychoses while a fourth described a situation where medications had already been prescribed but the patient was still experiencing psychotic problems.
Has a medicine failed the patient or has the patient failed to take the medicine?
On the whole, there was good correlation between audience selection and the e-health tool’s recommendations. However, some points for consideration did arise. For example, has a medicine failed the patient or has the patient failed to take the medicine? As treatment adherence is an important issue in the treatment of schizophrenia, such questions must be considered.
Clearly, it’s still early days for the e-health tool but its potential is certainly promising. As Dr Hemsley suggested, the proof of the pudding is in the eating!