Antipsychotic Cardiometabolic Side Effect Monitoring in a State Community Mental Health System

Abstract

Antipsychotic medications can cause serious cardiometabolic side effects. No recent research has broadly evaluated monitoring and strategies to improve monitoring in U.S. public mental health systems. To address this knowledge gap, we evaluated education with audit and feedback to leaders to improve cardiometabolic monitoring in a state mental health system. We used Chi square statistics and logistic regressions to explore changes in monitoring recorded in randomly sampled records over 2 years. In 2009, assessment of patients on antipsychotics was 29.6 % for cholesterol, 40.4 % for glucose, 29.1 % for triglycerides, 54.3 % for weight, 33.6 % for blood pressure, and 5.7 % for abdominal girth. In 2010, four of ten mental health centers improved their rate of adult laboratory monitoring. Overall monitoring in the state did not increase. Education for prescribers with audit and feedback to leaders can improve monitoring in some settings, but more intensive and/or prolonged interventions may be required.

Enhancing metabolic monitoring for children and adolescents using second‐generation antipsychotics

“…Previous research demonstrates that psychiatrist's metabolic monitoring behaviour is frequently insufficient (Connolly et al 2015;Cotes et al 2015;Delate et al 2014;Dhamane et al 2013;Honey et al 2013;Mitchell et al 2012;Rodday et al 2015). It is well known that the prescriber who initiates SGA therapy is assigned the primary responsibility of ensuring patients are appropriately monitored (Horn et al 2012).…”

“…This results in suboptimal monitoring rates during critical periods of SGA treatment such as at baseline, short-term, and long-term follow-up (Connolly et al 2015;Cotes et al 2015;Delate et al 2014;Dhamane et al 2013;Honey et al 2013;Mitchell et al 2012;Rodday et al 2015). Psychiatrists may operate independently and assume the sole responsibility of providing comprehensive care to their patients (i.e.…”

“…Despite availability of the CAMESA guidelines and established treatment recommendations to manage complications, there continues to be a gap in uptake (Cotes et al 2015;Ho et al 2011;Honey et al 2013;Rodday et al 2015). For instance, a retrospective analysis of U.S. paediatric patients newly initiated on SGAs (between 2002 and 2011) found that only 1 of 1023 patients received all of the recommended baseline and follow-up monitoring (Delate et al 2014).…”

“…However, previous research has demonstrated that this model has several drawbacks such as lack of resources for monitoring and lack of multidisciplinary staff and is threatened by high patient demand. This results in suboptimal monitoring rates during critical periods of SGA treatment such as at baseline, short-term, and long-term follow-up (Connolly et al 2015;Cotes et al 2015;Delate et al 2014;Dhamane et al 2013;Honey et al 2013;Mitchell et al 2012;Rodday et al 2015).…”

Prescribing antipsychotics in child and adolescent psychiatry: guideline adherence

“…disorderspecific guidelines, such as for the treatment of psychoses or schizophrenia [14], autism spectrum disorders (ASD) [15], bipolar disorder [16], or behavioral disorders [17][18][19], or guidelines addressing the use of antipsychotics in general [20][21][22][23][24]. Several studies have evaluated monitoring of antipsychotic use in clinical practice [25][26][27][28][29][30], but studies on the initiation of antipsychotics are scarce.…”