Improving Cardiometabolic Monitoring of Children on Antipsychotics

Cotes, Robert O.; Fernandes, Nisha K; McLaren, Jennifer; McHugo, Gregory J.; Bartels, Stephen J.; Brunette, Mary F.

doi:10.1089/cap.2017.0034

Cited by 15 publications

(19 citation statements)

References 13 publications

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“…In addition, unavailability of guidelines for the use of antipsychotics specific to children and adolescents might be one of the barriers in Japan, although two associations in the United States and Canada have proposed such guidelines (American Academy of Child and Adolescent Psychiatry 2011; Pringsheim et al 2011 ). To overcome barriers to conduct metabolic monitoring, there are several promising strategies, including formulation of a standardized metabolic monitoring protocol (Ronsley et al 2011 ), education of physicians with regular audits and feedback regarding metabolic monitoring (Cotes et al 2017 ), specialty certification that requires demonstration of practice performance improvement (Rodday et al 2015 ), a pop-up alert system that prompts physicians to order laboratory testing (DelMonte et al 2012 ), and an insurer-based prescription monitoring that requires peer review of the appropriateness of antipsychotic therapy (Maryland Medicaid 2011 ).…”

Section: Discussionmentioning

confidence: 99%

Glucose and Prolactin Monitoring in Children and Adolescents Initiating Antipsychotic Therapy

Okumura

Usami

Okada

et al. 2018

Journal of Child and Adolescent Psychopharmacology

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Objective: We aimed to evaluate glucose and prolactin monitoring in children and adolescents initiating antipsychotic therapy using a nationwide claims database.Methods: A retrospective 15-month cohort study was conducted using the National Database of Health Insurance Claim Information and Specified Medical Checkups in Japan. Patients aged ≤18 years, who were newly prescribed antipsychotics between April 2014 and March 2015, were followed up for 450 days. Outcomes were the use of glucose and prolactin testing through 15 months after drug initiation (index date) with consideration of persistence with antipsychotic therapy. The incidence proportion of patients monitored was assessed within the following four time windows: baseline (between 30 days before the index date and the index date), at 1–3 months (between 1 and 90 days after the index date), at 4–9 months (between 91 and 270 days after the index date), and at 10–15 months (between 271 and 450 days after the index date).Results: Of 43,608 new users in 6620 medical institutions, the percentage of persistent antipsychotic users was 46.4% at 90 days, 29.7% at 270 days, and 23.8% at 450 days after the index date. The proportion of patients who received monitoring within the baseline period was 13.5% (95% confidence interval [CI], 13.2–13.8) for glucose and 0.6% (95% CI, 0.5–0.6) for prolactin, respectively. The proportion of patients who received glucose monitoring at all time windows decreased to 0.9%. The proportion of patients who received prolactin monitoring by the second time window decreased to 0.1%.Conclusions: Our study shows that monitoring for glucose and prolactin is infrequent in children and adolescents initiating antipsychotic therapy. Strategies for physicians, patients, and guardians are needed to overcome the barriers in glucose and prolactin monitoring.

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Section: Discussionmentioning

confidence: 99%

Glucose and Prolactin Monitoring in Children and Adolescents Initiating Antipsychotic Therapy

Okumura

Usami

Okada

et al. 2018

Journal of Child and Adolescent Psychopharmacology

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“…This could be because these disorders are rare in children, or this information was not well-reported in the medical records and therefore missing. Previous studies have shown suboptimal monitoring frequencies in children treated with antipsychotic drugs and low compliance to monitoring guidelines (15,20,24). Improvement in monitoring practices is needed, which is seen not only in children treated with antipsychotic drugs, but also the monitoring frequencies for adults treated in psychiatric outpatient clinics have been shown to be suboptimal according to the guidelines (25).…”

Section: Discussionmentioning

confidence: 99%

Monitoring of Adverse Drug Reaction-Related Parameters in Children and Adolescents Treated With Antipsychotic Drugs in Psychiatric Outpatient Clinics

et al. 2021

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Aim: To assess the frequency of monitoring of adverse drug reaction (ADR) related parameters in children and adolescents treated with antipsychotic drugs in psychiatric outpatient clinics and the considerations when monitoring was not performed.Methods: This retrospective follow-up study included 100 randomly selected outpatients aged ≤18 years who had a first prescription of an antipsychotic drug recorded in the electronic medical records of psychiatric outpatient clinics between 2014 and 2017. They were followed for up to 3 years. This study assessed the frequency of monitoring for physical parameters (weight, height, body mass index, waist circumference, pulse, blood pressure, and an electrocardiogram) and laboratory parameters (glucose, lipids, and prolactin) before the first prescription of an antipsychotic drug as well as during its use. Monitoring frequencies were stratified by the patient characteristics (sex, age, cardiovascular risk factors, and use of other psychotropic drugs), and by location of antipsychotic drug initiation (psychiatric outpatient clinic or elsewhere). Additionally, this study assessed the considerations mentioned in the medical records for not monitoring ADR-related parameters.Results: Overall, physical parameters were monitored more frequently (weight: 85.9% during the first half-year) than laboratory parameters (glucose and cholesterol: both 23.5%). There were no significant differences in monitoring at least one physical as well as in monitoring at least one laboratory parameter during the baseline period and during the total follow-up of antipsychotic drug treatment between the patient characteristics. In total, 3% of the children and adolescents were never monitored for any physical parameter, and 54% were never monitored for any laboratory parameter. For a minority of the children (14.8%) who were never monitored for laboratory parameters, considerations were recorded in their medical records, including refusal by the child or parents and monitoring performed by the general practitioner or elsewhere.Conclusion: Monitoring frequencies of ADR-related parameters in children and adolescents treated with antipsychotic drugs in psychiatric outpatient clinics varied and especially monitoring of laboratory parameters was infrequent. Considerations why monitoring was not performed were rarely recorded. The optimal method of monitoring and documentation thereof should become clear to optimize the benefit-risk balance of antipsychotic drug treatment for each child.

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“…Seven articles met the inclusion criteria. We considered the articles by Cotes et al (2015Cotes et al ( , 2017 one as the latter is a long-term follow-up of the former. Figure 1 contains a flowchart of the search process and study selection according to the PRISMA guidelines (Moher et al 2009).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…All included studies were designed as clinical audit cycles with comparison between pre-and postintervention screening rates. All six studies were published between 2012 and 2018, four of which were reported between 2017 and 2018 (Cotes et al 2017;Washington 2017;Carpenter 2018;Featherston et al 2018). Four were published as peer-reviewed articles (Ronsley et al 2012;Cotes et al 2015;Pasha et al 2015;Featherston et al 2018) and two were dissertations (Washington 2017; Carpenter 2018).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Interventions to Improve Metabolic Risk Screening Among Children and Adolescents on Antipsychotic Medication: A Systematic Review

Melamed

LaChance

O’Neill

et al. 2021

Journal of Child and Adolescent Psychopharmacology

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Objective: Antipsychotic use among youth is common and is associated with metabolic side effects such as weight gain. Guidelines recommend periodic screening of metabolic measures in youth prescribed antipsychotics; however, a guidelineto-practice gap exists. We systematically reviewed the literature to synthesize the knowledge from interventions that aim to improve antipsychotic metabolic screening. We described the interventions' effect on screening rates, the strategies used for improvement, and study quality. Methods: We conducted a systematic review of studies that attempted to improve antipsychotic metabolic risk screening practices among pediatric populations published between 2004 and August 2019. We included studies with an improvement intervention that compared screening rates before and after the intervention. We extracted data about study characteristics, screening rates in pre-and postintervention groups, strategies used to influence screening practices, and assessed studies' risk of bias. This review was prospectively registered with PROSPERO #CRD42018088241. Results: We identified six studies that demonstrated modest improvements in median metabolic screening rates for waist circumference (0%-16%), glucose (9%-39%), and lipids (11%-37%). Median postintervention screening rates were higher for weight and blood pressure (84% and 72.5%) compared with glucose and lipids (39% and 37%). Interventions used a variety of improvement strategies to address patient-, provider-, and organization-level barriers for screening, including increasing patient and provider knowledge regarding antipsychotic side effects, fostering social clinical environments that promote screening, and organizational commitment for screening antipsychotic-treated youth. All interventions were deemed at high risk of bias due to uncontrolled design and lack of adjustment for confounders. Conclusions: Included studies reported partial success in improving antipsychotic screening rates but were of poor methodological quality. Common improvement strategies may affect provider behavior to conduct metabolic screening, but these need to be tailored to local resources and organization structure. Future studies need to use rigorous methodology and theoryinformed improvement strategies aligned with organizational actions to prioritize safe and judicious practice of antipsychotics among pediatric populations.

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Improving Cardiometabolic Monitoring of Children on Antipsychotics

Cited by 15 publications

References 13 publications

Glucose and Prolactin Monitoring in Children and Adolescents Initiating Antipsychotic Therapy

Glucose and Prolactin Monitoring in Children and Adolescents Initiating Antipsychotic Therapy

Monitoring of Adverse Drug Reaction-Related Parameters in Children and Adolescents Treated With Antipsychotic Drugs in Psychiatric Outpatient Clinics

Interventions to Improve Metabolic Risk Screening Among Children and Adolescents on Antipsychotic Medication: A Systematic Review

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