Background
Antipsychotics (APs) increase weight, metabolic syndrome, diabetes and cardiovascular disease. Guidelines recommend cardio-metabolic monitoring at initial assessment, at 3 months and then annually in people prescribed APs.
Aim
To determine the rates of cardio-metabolic monitoring in AP treated early and chronic psychosis and to assess the impact of targeted improvement strategies.
Methods
Medical records were reviewed in two cohorts of first-episode psychosis (FEP) patients before and after the implementation of a physical health parameter checklist and electronic laboratory order set. In a separate group of patients with chronic psychotic disorders, adherence to annual monitoring was assessed before and 3 months after an awareness-raising educational intervention.
Results
In FEP, fasting glucose (39% vs 67%,
p
=0.05), HbA1c (0% vs 24%,
p
=0.005) and prolactin (18% vs 67%,
p
=0.001) monitoring improved. There were no significant differences in weight (67% vs 67%,
p
=1.0), BMI (3% vs 10%,
p
=0.54), waist circumference (3% vs 0%,
p
=1.0), fasting lipids (61% vs 76%
p
=0.22) or ECG monitoring (67% vs 67%,
p
=1.0). Blood pressure (BP) (88% vs 57%,
p
=0.04) and heart rate (91% vs 65%,
p
=0.03) monitoring dis-improved. Diet (0%) and exercise (<15%) assessment was poor. In chronic psychotic disorders, BP monitoring improved (20% vs 41.4%,
p
=0.05), whereas weight (17.0% vs 34.1%,
p
=0.12), BMI (9.7% vs 12.1%,
p
=1.0), fasting glucose (17% vs 24.3%,
p
=0.58) and fasting lipids remained unchanged (17% vs 24.3%,
p
=0.58).
Conclusions
Targeted improvement strategies resulted in a significant improvement in a limited number of parameters in early and chronic psychotic disorders. Overall, monitoring remained suboptimal.
