A Case Control Study of the Implementation of Change Model Versus Passive Dissemination of Practice Guidelines for Compliance in Monitoring for Metabolic Syndrome

Abstract

We developed an intervention to improve compliance with guidelines for monitoring metabolic syndrome and compared compliance prior to intervention and three times post-intervention at three community mental health clinics in Texas. One test clinic received intervention and two other clinics served as controls. Fifty random charts were reviewed from each clinic for three specific, 1-2 weeks periods over the course of 18 months. There were significant improvements in the ordering of labs, the presence of lab results in the chart, and documentation of blood pressure, body mass index and waist circumference in the intervention clinic over time in comparison to the control clinics. Documented evidence of physician action with respect to out of range values remained low. Metabolic monitoring is a multi-step process. Removing barriers, creating specific procedures, and dedicating staff resources can improve compliance with monitoring.

Physical health assessment and cardiometabolic monitoring practices across three adult mental health inpatient units – a retrospective cohort study

“…Service‐related barriers are encountered where there are low levels of organizational and cultural support for guideline recommended CMM practices (Velligan et al . 2013). The absence of equipment required to complete CMM was also identified as a barrier (Hetrick et al .…”

“…2013; Velligan et al . 2013). Considering the well‐documented disproportionate risk of cardiometabolic comorbidities and associated mortality (Galletly et al .…”

Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness

“…Several excellent NIH-funded investigators and SAMHSA-funded administrators have been working hard to develop models to improve the health care of people with SMI. For example, investigators have conducted trials studying satellite primary care clinics [ 23 ], peer-led medical disease self-management [ 49 – 51 ], electronic reminders to providers or patients [ 52 ], a clinical decision support program for primary care providers treating people with SMI [ 53 , 54 ], care coordination [ 23 , 41 – 43 , 45 ], provider education [ 55 ], and other patient-centered approaches [ 44 , 47 , 56 – 58 ]. None of these studies target provider behavior by expanding the scope of practice of community psychiatrists.…”

A Randomized Controlled Trial of a Patient-Centered Approach to Improve Screening for the Metabolic Side Effects of Antipsychotic Medications

“…A number of programs to improve monitoring for the metabolic adverse effects of antipsychotic medications that go beyond passive dissemination of guidelines have been described (Barnes et al 2008; Schneiderhan et al 2009; Nicol et al 2011; Thompson et al 2011; DelMonte et al 2012; Ramanuj 2013; Velligan et al 2013). These programs included interventions for clinicians or clinics comprised of one, and often multiple, components including educational sessions (Barnes et al 2008; Nicol et al 2011; Thompson et al 2011; Ramanuj 2013; Velligan et al 2013), posting of printed educational materials (Barnes et al 2008; Thompson et al 2011; Ramanuj 2013), audit and feedback on monitoring practices (Barnes et al 2008; Nicol et al 2011; Ramanuj 2013), paper reminders about monitoring placed in medical charts (Nicol et al 2011; Thompson et al 2011), computerized reminders about monitoring at the time of antipsychotic prescribing (DelMonte et al 2012), and provision of implementation tools (e.g., monitoring equipment) (Thompson et al 2011) and other delivery system and procedural interventions (e.g., hiring of a medical assistant charged with ensuring labs were drawn and results presented on a metabolic tracking form, implementation of a pharmacist or nurse-led metabolic monitoring clinic) (Schneiderhan et al 2009; Velligan et al 2013).…”

“…These programs included interventions for clinicians or clinics comprised of one, and often multiple, components including educational sessions (Barnes et al 2008; Nicol et al 2011; Thompson et al 2011; Ramanuj 2013; Velligan et al 2013), posting of printed educational materials (Barnes et al 2008; Thompson et al 2011; Ramanuj 2013), audit and feedback on monitoring practices (Barnes et al 2008; Nicol et al 2011; Ramanuj 2013), paper reminders about monitoring placed in medical charts (Nicol et al 2011; Thompson et al 2011), computerized reminders about monitoring at the time of antipsychotic prescribing (DelMonte et al 2012), and provision of implementation tools (e.g., monitoring equipment) (Thompson et al 2011) and other delivery system and procedural interventions (e.g., hiring of a medical assistant charged with ensuring labs were drawn and results presented on a metabolic tracking form, implementation of a pharmacist or nurse-led metabolic monitoring clinic) (Schneiderhan et al 2009; Velligan et al 2013). Although shown to be effective in increasing rates of metabolic monitoring, these interventions consisted predominately of quality improvement programs evaluated with non-randomized designs in small samples, only some of which included comparison groups (Nicol et al 2011; DelMonte et al 2012; Velligan et al 2013). In addition, none of these interventions targeted individuals with serious mental illness as potential agents of change in improving rates of metabolic monitoring within a patient-centered care framework.…”