Metabolic Syndrome Screening and Assertive Community Treatment

Abstract

Metabolic syndrome defines a collection of cardiometabolic illnesses that predict risk for poor physical health and early death and is highly prevalent among those with serious mental illness. Despite recommendations for routine monitoring, those with serious mental illness frequently do not receive physical health screenings. We conducted a quality improvement (QI) project to increase rates of metabolic syndrome screening in three New York City Assertive Community Treatment (ACT) teams. The project, conducted from December 2010 to May 2011, involved educational sessions for staff and consumers and a systematic screening protocol. We collected complete metabolic syndrome screening measurements for 71% of participating ACT consumers. We found metabolic risk to be nearly universal among participants, with over half diagnosed with metabolic syndrome. We also found high rates of previously undiagnosed hypertension, diabetes, and dyslipidemia. We describe the resources and obstacles we encountered in our QI project to make systematic metabolic screening a routine part of ACT care. This QI project suggests that ACT teams can take a leadership role in screening their consumers for physical health issues, aligning with recent policy trends to better integrate behavioral health and primary care services.

Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review

“…Studies broadly either tested a new tool to facilitate screening for health professionals 28 32 33 35–39 47 (online supplementary table 1 ) or made complex health services delivery changes 26 29–31 40–46 48 (online supplementary table 2 ). One intervention 26 primarily targeted service users, though in other studies 29 40 44 service user-focused interventions were included, for instance targeted education, 33 40 self-management support 44 or support to attend screening. 29 Most studies included staff education 38 40 43 45 46 48 and training 28 33 35 39 42 as part of the intervention.…”

“… 28 34–37 39 MS monitoring was evaluated using the following measurements: BP, smoking status, waist circumference (WC), fasting blood glucose (BG), BMI, triglycerides and HDL-C. These measures were based on the following clinical guidelines: National Institute for health and Care Excellence 26 31 35–37 39–41 ; Maudsley Prescribing Guidelines 34 37 40–42 ; US Preventive Services Task Force 30 44 ; National Heart, Lung and Blood Institute 33 ; American Diabetes Association 32–34 38 47 ; Early Psychosis Prevention and Intervention Centre 43 ; Psychotropic Therapeutic Guidelines 48 and the American Psychiatric Association Practice. 28 35 38 Most interventions were multifaceted, so will appear in more than one cluster.…”

Metabolic Syndrome Screening Among Inpatient Psychiatric Patients

“…Among this sample, over 60% had at least one metabolic comorbidity. Another study supported this outcome and found among 67 patients with bipolar disorder, 53.7% had co-occurring metabolic syndrome (Kumar, et al, 2017) while Castillo, Rosati, Williams, Pessin, & Lindy (2015) found a 52% prevalence among 10,084 psychiatric outpatients with varying diagnoses.…”

“…These patients are three times more likely to die of cardiovascular-related causes; however, this population is not routinely assessed for metabolic syndrome and furthermore, patients with known hypertension, hyperlipidemia, and diabetes in this population frequently lack appropriate treatment. Missed or untreated metabolic syndrome diagnoses are associated with increased length of stay, mortality during hospitalization, and 30-day all-cause readmission rates (Castillo, Rosati, Williams, Pessin, & Lindy, 2015).…”

“…This indicator also monitored for treatment follow-up based on completed screens. This is a crucial indicator due to the prevalence of diagnoses without treatment(Castillo, Rosati, Williams, Pessin, & Lindy, 2015).Measures. Current practice does not actively identify patients at high risk for metabolic syndrome so project outcome indicators included screening for metabolic syndrome risk criteria for 80% of admitted patients and treatment initiation of 50% of positively screened patients.…”