Adherence to metabolic monitoring guidelines in atypical antipsychotic treated subjects: Do physicians comply?

Abstract

Since the 1990s, the arrival of the new generation of antipsychotics, the atypical antipsychotics (AAP), heralded a new era in the management on psychotic patients as they are associated with much less side effects as the older drugs. However, the psychiatric community soon realized a new problem had emerged with these drugs, namely severe metabolic side effects. Several monitoring guidelines were soon published to guide treating physicians on how to deal with this issue. This study was aimed to assess adherence to the recommended guidelines by Malaysian doctors. Data concerning metabolic monitoring over 1 year were collected from 405 subjects newly started on AAP after June 2005, when the recommended guidelines were first implemented. Results showed that almost all the recommended tests/procedures were performed in less than 50% of patients during the recommended designated times. We recommend that the guidelines, which now serve only as a "guide", be made a compulsory practice to safeguard the health of our patients.

Improving Adherence to Atypical Antipsychotic Agent Screening Guidelines in Pediatric Patients: A Quality Improvement Project Within an Integrated Community Mental Health Setting

“…Although all variables showed positive statistically significant findings, there is still a consistent gap between recommended practices and actual practices as found in previous studies (Bauer, 2002; Gill et al, 2012; Mitchell et al, 2012; Morrato et al, 2010; Pappadopulos et al, 2002). WC and family history are the two variables with the lowest adherence.…”

“…Although practice parameters and recommended screening guidelines are available, a discrepancy between best practices and actual practices has been shown (Gill, Tan, Lee, Tan, & Jawan, 2012; Morrato et al, 2010; Pappadopulos et al, 2002). In a literature review conducted by Bauer (2002), adequate adherence to guidelines was found 27% of the time in cross-sectional studies and in those studies looking at pre– and post–guideline implementations.…”

Monitoring of Metabolic Adverse Effects Associated With Atypical Antipsychotics Use in an Outpatient Psychiatric Clinic

“…Since our results for overall monitoring compliance for major parameters showed similar array with the numbers reported in the literature, 3 we believe that the number of 38% reflects a real situation with follow-up monitoring period and is not merely a result of flawed study design ( Figure 2). As suggested by previous research, [8][9][10][11] we speculated several reasons for the lower compliance during the follow-up period. The most apparent one is that practitioners may not remember to order the tests on time due to the variable guideline requirements for each parameter at the specified intervals that make up the follow-up period.…”

“…Third, although the pattern of our results suggest that complexity or variability of the guidelines may be the major reason for decreased compliance, it may also be influenced by the factors described in previous reports as well. [8][9][10][11] Fourth, the monitoring percentages presented may be underestimated since our study did not capture data on services provided by outside PCP providers who have no access to BHMC EMR. The common practice in the clinic is to encourage patients to bring all recent outside laboratory reports, review them, and scan into the "Media" section in EPIC.…”

“…To the best of our knowledge, this is the first study conducted in the US population evaluating each specific interval to report compliance with the current guideline recommendations. We were only able to identify 1 study conducted in Malaysia by Gill et al 10 that reported percentages at each recommended interval. However, the study demonstrated higher compliance of 5.2% to 62.7% at initiation of antipsychotic depending on the parameter, with a drop in compliance to 0.6% to 12.2% for all other periods (including annual period).…”