Barriers to monitoring and management of cardiovascular and metabolic health of patients prescribed antipsychotic drugs: a systematic review

Ali, Ruba Azfr; Jalal, Zahraa; Paudyal, Vibhu

doi:10.1186/s12888-020-02990-6

Cited by 21 publications

(18 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, important gaps in the routine screening of metabolic disorders are found in clinical practice [ 82 ]. The barriers associated with these gaps include healthcare system-related factors such as the fragmentation of care and time and resources constraints, and patient-related factors such as disability resulting from mental health conditions, knowledge, and skills of the patients [ 83 ].…”

Section: Discussionmentioning

confidence: 99%

Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies

et al. 2021

View full text Add to dashboard Cite

Introduction: To assess the risk of occurrence and potential determinants of metabolic disorders in adult patients treated with second-generation antipsychotics (SGAs) under real-world practice conditions. Methods: MEDLINE, EMBASE, and PsycInfo were searched in July 2019 from database inception. We included population-based, longitudinal, comparative studies that report the results of the outcomes of interest for adult participants, including diabetes, ketoacidosis, hyperosmolar hyperglycemic state, weight gain/ obesity, dyslipidemia, hypertension, and metabolic syndrome. Two reviewers independently extracted data on the study design, study quality, and study outcomes. Results: We included 40 studies. Most studies showed that clozapine and olanzapine were associated with an increased likelihood of developing diabetes, while the results for risperidone and quetiapine were mixed. Although less well studied, ziprasidone and aripiprazole appeared to not be associated with the occurrence of diabetes. Information on antipsychotic-induced weight gain/obesity is extremely scarce. Regarding dyslipidemia, aripiprazole was not associated with an increased likelihood of developing dyslipidemia, clozapine was associated with an increased likelihood of developing dyslipidemia, and risperidone, olanzapine, quetiapine, and ziprasidone showed mixed results. Two studies suggested an association between ziprasidone and the occurrence of hypertension. Several studies found that the occurrence of a metabolic disorder acted as a risk factor for the development of other metabolic disorders. We did not find information on brexpiprazole, cariprazine, or lurasidone, and data on any long-acting SGA were lacking. Conclusion: Although there are relevant differences among SGAs concerning the risk of metabolic disorders,

show abstract

Section: Discussionmentioning

confidence: 99%

Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies

et al. 2021

View full text Add to dashboard Cite

show abstract

“…[43][44][45][46] Clinical guidelines should be inclusive of social outcomes such as homelessness when providing services for substance misuse and severe mental illnesses. [47][48]…”

Section: Implications For Practice and Researchmentioning

confidence: 99%

Representation of persons experiencing homelessness and coding of homelessness in general practices: descriptive evaluation using healthcare utilisation data

et al. 2021

Self Cite

View full text Add to dashboard Cite

BackgroundEpidemiological studies focused on primary healthcare needs of persons experiencing homelessness (PEH) are often based on data from specialist homeless healthcare services.AimThe aim of this study is to explore the presentation of PEH, coding of homelessness and associated health conditions in mainstream primary care general practices in England.Design & settingEMIS electronic database search of medical records was conducted across 48 general practices in a Clinical Commissioning Group (CCG), representing one of the most socioeconomically deprived regions in England, which also lacks a specialist primary healthcare service for PEH.MethodKey terms and codes were used to identify PEH, their respective diagnoses across 22 health conditions and prescribed medications over the past 4 years.ResultsFrom a population of approximately 321,000, 43 (0.013%) persons were coded as PEH compared to a homelessness prevalence of 0.5% in the English general population. Mental health conditions were the most prevalent diagnoses amongst the PEH registrants (62.3%); the recorded prevalence of other common long-term conditions in PEH was lower than the levels observed in PEH registered with specialist homelessness health services.ConclusionIn a population with approximately four times higher rate of statutory homelessness, PEH representation in mainstream general practices was underrepresented by several folds. As homelessness overlaps with mental health, substance misuse and long term health conditions, consistent coding of homelessness in medical records is imperative to offer tailored support and prevention actions when patients present for services.

show abstract

“…A systematic review identified several multidimensional barriers to adequate monitoring for patients on antipsychotic medication. 56 Considering the variation between practices, it has previously been suggested that there are marked variations in mental health prescribing between general practices in the UK. [57][58][59][60] However, the variation in the prevalence of PSIs has only been examined in the UK using general (non-mental health specific) sets of PSIs.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD)

et al. 2021

View full text Add to dashboard Cite

BackgroundMost patients with mental illness are managed in primary care, yet there is a lack of data exploring potential prescribing safety issues in this setting for this population.ObjectivesExamine the prevalence of, between-practice variation in, and patient and practice-level risk factors for, 18 mental health-related potentially hazardous prescribing indicators and four inadequate medication monitoring indicators in UK primary care.MethodCross-sectional analyses of routinely collected electronic health records from 361 practices contributing to Clinical Practice Research Datalink GOLD database. The proportion of patients ‘at risk’ (based on an existing diagnosis, medication, age and/or sex) triggering each indicator and composite indicator was calculated. To examine between-practice variation, intraclass correlation coefficient (ICC) and median OR (MOR) were estimated using two-level logistic regression models. The relationship between patient and practice characteristics and risk of triggering composites including 16 of the 18 prescribing indicators and four monitoring indicators were assessed using multilevel logistic regression.Results9.4% of patients ‘at risk’ (151 469 of 1 611 129) triggered at least one potentially hazardous prescribing indicator; between practices this ranged from 3.2% to 24.1% (ICC 0.03, MOR 1.22). For inadequate monitoring, 90.2% of patients ‘at risk’ (38 671 of 42 879) triggered at least one indicator; between practices this ranged from 33.3% to 100% (ICC 0.26, MOR 2.86). Patients aged 35–44, females and those receiving more than 10 repeat prescriptions were at greatest risk of triggering a prescribing indicator. Patients aged less than 25, females and those with one or no repeat prescription were at greatest risk of triggering a monitoring indicator.ConclusionPotentially hazardous prescribing and inadequate medication monitoring commonly affect patients with mental illness in primary care, with marked between-practice variation for some indicators. These findings support health providers to identify improvement targets and inform development of improvement efforts to reduce medication-related harm.

show abstract

Barriers to monitoring and management of cardiovascular and metabolic health of patients prescribed antipsychotic drugs: a systematic review

Cited by 21 publications

References 43 publications

Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies

Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies

Representation of persons experiencing homelessness and coding of homelessness in general practices: descriptive evaluation using healthcare utilisation data

Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD)

Contact Info

Product

Resources

About