Metabolic Monitoring Training Program Implementation in the Community Setting Was Associated with Improved Monitoring in Second-Generation Antipsychotic-Treated Children

Ronsley, Rebecca; Rayter, Mark; Smith, Derryck H.; Davidson, Jana; Panagiotopoulos, Constadina

doi:10.1177/070674371205700504

Cited by 23 publications

(31 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No study addressed the moderators of harms. The evidence base included RCTs (some of which were cluster RCTs) [13, 14, 46–48, 50, 51, 53, 55–62], (nonrandomized) controlled clinical trials (CCTs) [52, 54], interrupted time series [49], and cohort designs [55]. Full evidence tables for articles identified via searches through January 14, 2016, are available at http://srdr.ahrq.gov/projects/530.…”

Section: Resultsmentioning

confidence: 99%

“…In this instance, implementation competence was defined as therapists demonstrating competent delivery of all components of at least one Adolescent Community Reinforcement Approach (A-CRA, an EBP program) treatment procedure during the same treatment session for 1 month. Other outcomes for which we found evidence of benefit (low strength of evidence of benefit) included:Improved practitioner adherence to EBPs or guidelines: by training practitioners to monitor metabolic markers [49], providing computer decision support plus an electronic health record (EHR) that included diagnosis and treatment guidelines [46], or offering an Internet portal for practitioner access to practice guidelines [56]Improved practitioner morale, engagement, and stress: by implementing a program to enhance organizational climate and culture [51]Improved patient access to care, parent satisfaction, treatment engagement, and therapeutic alliance: by training nurses to educate parents about EBPs [55]Improved patient functional status: by giving practitioners weekly feedback on patient symptoms and functioning [13]Improved service utilization: by training practitioners about monitoring medications [49] and appropriately identifying and referring patients with mental health problems [48]. …”

Section: Resultsmentioning

confidence: 99%

“…Improved practitioner adherence to EBPs or guidelines: by training practitioners to monitor metabolic markers [49], providing computer decision support plus an electronic health record (EHR) that included diagnosis and treatment guidelines [46], or offering an Internet portal for practitioner access to practice guidelines [56]…”

Section: Resultsmentioning

confidence: 99%

“…Improved service utilization: by training practitioners about monitoring medications [49] and appropriately identifying and referring patients with mental health problems [48]. …”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review

et al. 2017

View full text Add to dashboard Cite

BackgroundSome outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) assess the effectiveness of quality improvement, implementation, and dissemination strategies intended to improve the mental health care of children and adolescents; (2) examine harms associated with these strategies; and (3) determine whether effectiveness or harms differ for subgroups based on system, organizational, practitioner, or patient characteristics.MethodsSources included MEDLINE®, the Cochrane Library, PsycINFO, and CINAHL, from database inception through February 17, 2017. Additional sources included gray literature, additional studies from reference lists, and technical experts. Two reviewers selected relevant randomized controlled trials (RCTs) and observational studies, extracted data, and assessed risk of bias. Dual analysis, synthesis, and grading of the strength of evidence for each outcome followed for studies meeting inclusion criteria. We also used qualitative comparative analysis to examine relationships between combinations of strategy components and improvements in outcomes.ResultsWe identified 18 strategies described in 19 studies. Eleven strategies significantly improved at least one measure of intermediate outcomes, final health outcomes, or resource use. Moderate strength of evidence (from one RCT) supported using provider financial incentives such as pay for performance to improve the competence with which practitioners can implement evidence-based practices (EBPs). We found inconsistent evidence involving strategies with educational meetings, materials, and outreach; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information. We also found low strength of evidence for no benefit for initiatives that included only educational materials or meetings (or both), or only educational materials and outreach components. Evidence was insufficient to draw conclusions on harms and moderators of interventions.ConclusionsSeveral strategies can improve both intermediate and final health outcomes and resource use. This complex and heterogeneous body of evidence does not permit us to have a high degree of confidence about the efficacy of any one strategy because we generally found only a single study testing each strategy.Trial registrationPROSPERO, CRD42015024759.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Improved service utilization: by training practitioners about monitoring medications [49] and appropriately identifying and referring patients with mental health problems [48]. …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Psychotropic medications are however, recommended to be initiated for children in specialist-level health care services (5), with the exception of attention deficit hyperactivity disorder medication (methylphenidate). Recommendations and follow-up protocols seem to be helpful in clinical work and appear to increase monitoring and possibly have an effect on prescribing practices (7,43,44). Despite the already existing recommendations, there has been a lag in the translation of research evidence into clinical practice (39,45).…”

Section: Introductionmentioning

confidence: 99%

Clinical use of second-generation antipsychotics in children

Kakko

Pihlakoski

Salmelin

et al. 2017

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

View full text Add to dashboard Cite

Background: The use of second-generation antipsychotic (SGA) medication among child and adolescent psychiatric patients has increased worldwide in recent years. The increase appears to have been more extensive in the USA than in European countries, but the tendency is similar. However, after a peak the use seems to have declined in the USA. Simultaneously with the increasing numbers, the duration of SGA use has lengthened, indications have broadened, and off-label use has increased. Despite existing follow-up recommendations and evidence for the metabolic adverse effects of SGAs in children, research evidence has not translated into clinical practice. Objective: The aim of this study was to assess the clinical use and follow-up practices of SGA medication among child psychiatric patients of one university hospital in Finland. Method: This retrospective patient report-based study was conducted at the Child Psychiatric Clinic of Tampere University Hospital, Finland. The study sample consisted of 133 patients who were younger than 13 years when initiating SGA treatment and had an ongoing SGA medication during the study period. The study sample was divided into two groups according to diagnosis to examine whether there were differences between patients with an autistic or a developmental disorder (F83-84) and patients with other psychiatric diagnoses. Results: This study showed that SGA use in children younger than 13 years was mainly off-label. Irrespective of diagnosis, the most common indication was aggression. Especially children with psychiatric diagnoses other than developmental disorders had multiple socio-demographic risk factors and adverse life experiences in their background. The follow-up practices were diverse and partly irregular. Conclusions: A need for systematic SGA monitoring practices and dialogue between the medical specialities treating children and their families is evident.

show abstract

Type 2 Diabetes Mellitus in Youth Exposed to Antipsychotics

et al. 2016

View full text Add to dashboard Cite

IMPORTANCE Antipsychotics are used increasingly in youth for nonpsychotic and off-label indications, but cardiometabolic adverse effects and (especially) type 2 diabetes mellitus (T2DM) risk have raised additional concern. OBJECTIVE To assess T2DM risk associated with antipsychotic treatment in youth. DATA SOURCES Systematic literature search of PubMed and PsycINFO without language restrictions from database inception until May 4, 2015. Data analyses were performed in July 2015, and additional analyses were added in November 2015. STUDY SELECTION Longitudinal studies reporting on T2DM incidence in youth 2 to 24 years old exposed to antipsychotics for at least 3 months. DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted study-level data for a random-effects meta-analysis and meta-regression of T2DM risk. MAIN OUTCOMES AND MEASURES The coprimary outcomes were study-defined T2DM, expressed as cumulative T2DM risk or as T2DM incidence rate per patient-years. Secondary outcomes included the comparison of the coprimary outcomes in antipsychotic-treated youth with psychiatric controls not receiving antipsychotics or with healthy controls RESULTS Thirteen studies were included in the meta-analysis, including 185 105 youth exposed to antipsychotics and 310 438 patient-years. The mean (SD) age of patients was 14.1 (2.1) years, and 59.5% were male. The mean (SD) follow-up was 1.7 (2.3) years. Among them, 7 studies included psychiatric controls (1 342 121 patients and 2 071 135 patient-years), and 8 studies included healthy controls (298 803 patients and 463 084 patient-years). Antipsychotic-exposed youth had a cumulative T2DM risk of 5.72 (95% CI, 3.45-9.48; P < .001) per 1000 patients. The incidence rate was 3.09 (95% CI, 2.35-3.82; P < .001) cases per 1000 patient-years. Compared with healthy controls, cumulative T2DM risk (odds ratio [OR], 2.58; 95% CI, 1.56-4.24; P < .0001) and incidence rate ratio (IRR) (IRR, 3.02; 95% CI, 1.71-5.35; P < .0001) were significantly greater in antipsychotic-exposed youth. Similarly, compared with psychiatric controls, antipsychotic-exposed youth had significantly higher cumulative T2DM risk (OR, 2.09; 95% CI, 1.50-52.90; P < .0001) and IRR (IRR, 1.79; 95% CI, 1.31-2.44; P < .0001). In multivariable meta-regression analyses of 10 studies, greater cumulative T2DM risk was associated with longer follow-up (P < .001), olanzapine prescription (P < .001), and male sex (P = .002) (r 2 = 1.00, P < .001). Greater T2DM incidence was associated with second-generation antipsychotic prescription (P Յ .050) and less autism spectrum disorder diagnosis (P = .048) (r 2 = 0.21, P = .044). CONCLUSIONS AND RELEVANCE Although T2DM seems rare in antipsychotic-exposed youth, cumulative risk and exposure-adjusted incidences and IRRs were significantly higher than in healthy controls and psychiatric controls. Olanzapine treatment and antipsychotic exposure time were the main modifiable risk factors for T2DM development in antipsychotic-exposed youth. Antipsychotics should be used judiciously an...

show abstract

Metabolic Monitoring Training Program Implementation in the Community Setting Was Associated with Improved Monitoring in Second-Generation Antipsychotic-Treated Children

Cited by 23 publications

References 23 publications

Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review

Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review

Clinical use of second-generation antipsychotics in children

Type 2 Diabetes Mellitus in Youth Exposed to Antipsychotics

Contact Info

Product

Resources

About