Persistence of metabolic monitoring for psychiatry inpatients treated with second-generation antipsychotics utilizing a computer-based intervention

Lee, J.; Dalack, Gregory W.; Casher, Michael I.; Eappen, Sunil; Bostwick, Jolene R.

doi:10.1111/jcpt.12368

Cited by 11 publications

(27 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The majority of these (n = 25) were quantitative, 4 were qualitative [73][74][75][76] and 4 of a mixed methods [77][78][79][80] study design. Twenty of these studies included a study intervention where quantitative outcome data allowed for impact to be assessed-statistical tests of significance of data obtained for outcome parameters reported by study authors (a pre-post study design (n = 14)) or they compared groups where study intervention was implemented against group where the study intervention was not implemented (a case-control study design (n = 5) [78,79,[81][82][83] or randomised controlled study (n = 1) [84]. Table 3 shows that the most common setting for study intervention was a community mental health/psychiatric outpatient clinic (n = 15), followed by psychiatric inpatient wards (n = 12).…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…One study was based in early intervention/psychosis services [86] and one based in other (mix of urban, non-urban and metropolitan centres) [71,72]. Pharmacists were involved to some extent in delivering the interventions across all studies, and those involved were mostly commonly specialist mental health/psychiatric pharmacists (n = 9) [73,79,83,[85][86][87][88][89][90] or clinical pharmacists (n = 9) [76,78,81,82,[91][92][93][94][95] (Table 4). Differences in terminology across studies due to differences in country of origin did not allow us to differentiate grades or qualification of pharmacists.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review

et al. 2021

View full text Add to dashboard Cite

Background Individuals with severe mental illness, e.g. schizophrenia have up to a 20% shortened life expectancy compared to the general population. Cardiovascular disease, due to cardiometabolic risk and metabolic syndrome, accounts for most of this excess mortality. A scoping search revealed that there has not been a review of published studies on the role of pharmacy in relation to cardiometabolic risk, metabolic syndrome and related diseases (e.g. type 2 diabetes) in individuals with severe mental illness. Methods A mixed-methods systematic review was performed. Eleven databases were searched using a comprehensive search strategy to identify English-language studies where pharmacy was involved in an intervention for cardiometabolic risk, metabolic syndrome or related diseases in severe mental illness in any study setting from any country of origin. First, a mapping review was conducted. Then, implementation strategies used to implement the study intervention were classified using the Cochrane Effective Practice and Organisation of Care Taxonomy. Impact of the study intervention on the process (e.g. rate of diagnosis of metabolic syndrome) and clinical (e.g. diabetic control) outcomes were analysed where possible (statistical tests of significance obtained for quantitative outcome parameters reported). Quality assessment was undertaken using a modified Mixed Methods Appraisal Tool. Results A total of 33 studies were identified. Studies were heterogeneous for all characteristics. A total of 20 studies reported quantitative outcome data that allowed for detailed analysis of the impact of the study intervention. The relationship between the total number of implementation strategies used and impact on outcomes measured is unclear. Inclusion of face-to-face interaction in implementation of interventions appears to be important in having a statistically significantly positive impact on measured outcomes even when used on its own. Few studies included pharmacy staff in community or general practitioner practices (n = 2), clinical outcomes, follow up of individuals after implementation of interventions (n = 3). No studies included synthesis of qualitative data. Conclusions Our findings indicate that implementation strategies involving face-to-face interaction of pharmacists with other members of the multidisciplinary team can improve process outcomes when used as the sole strategy. Further work is needed on clinical outcomes (e.g. cardiovascular risk reduction), role of community pharmacy and qualitative studies. Systematic review registration PROSPERO CRD42018086411

show abstract

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…One study found nearly 30% of inpatients prescribed at least one SGA met criteria for metabolic syndrome 7 . In 2004, to address risks of increased metabolic adverse effects, the American Diabetes Association (ADA) and the American Psychiatric Association (APA) released a set of guidelines on metabolic monitoring in patients taking SGAs, which have not been widely implemented in psychiatric settings 8,9 . Since the release of these guidelines, steps have been taken to increase the monitoring of these laboratory (lab) values.…”

Section: What Is Known and Objectivementioning

confidence: 99%

The effect of a computerized best practice alert system in an outpatient setting on metabolic monitoring in patients on second‐generation antipsychotics

et al. 2020

View full text Add to dashboard Cite

What is known and objective Metabolic syndrome is a well‐documented adverse effect of second‐generation antipsychotics (SGAs). Patients with metabolic syndrome are at an increased risk of potentially fatal cardiovascular events, including myocardial infarction and stroke. This elevated risk prompted the creation of a national guideline on metabolic monitoring for patients on SGAs in 2004. However, monitoring practices remained low at our clinic. To address this concern, a clinical decision support system was developed to alert providers of monitoring requirements. The purpose of this study is to determine the effect of the best practice alert (BPA), and to assess the impact of provider and patient characteristics on metabolic laboratory (lab) order rates. Methods A retrospective chart review was conducted at a large outpatient psychiatric clinic. Data were collected from all adult patients who were prescribed an SGA and triggered the BPA (indicating lab monitoring is needed for the patient). Data collection included a variety of patient, provider and alert variables. The primary outcome was a composite of fasting blood glucose (FBG), haemoglobin A1c (HbA1c) and/or fasting lipid panel order rates. Secondary outcomes included the rate of valid response, which considered appropriate reasons for not ordering labs (ie monitoring already completed during recent primary care visit), as well as order rates of individual labs. Results and Discussion Data from 1112 patients were collected and analysed. Patients with a thought disorder diagnosis had significantly more labs ordered than those without. No other patient factors affected order rates. Resident psychiatrists and nurse practitioners ordered significantly more labs and had significantly more valid responses than attending psychiatrists. An active alert, which fired during medication order entry, was associated with a higher rate of lab ordering and valid response compared to a passive alert, which fired whenever a prescribing healthcare provider opened the chart. What is new and conclusion Prescribers may associate metabolic syndrome with schizophrenia or with use of SGAs specifically in thought disorders, even though these medications pose a risk for all indications. Higher rates of monitoring by resident physicians may have been due to spending more time with patients during the encounter and in documentation. Lastly, the active BPA was an effective tool to increase metabolic monitoring in patients taking SGAs. Continued education on the importance of regular metabolic monitoring should be implemented for all providers.

show abstract

“…Despite the well-documented association between serious mental illness and increased risk of diabetes and cardiovascular disease, studies consistently demonstrate poor health screening and monitoring in this group of patients. 20,21 A systematic review and meta-analysis of pooled data from 5 countries, involving 218,940 patients with severe mental illness at baseline and 71,594 patients after guideline introduction, concluded that metabolic monitoring rates for patients with mental illness on antipsychotic medication were low. 20 The only parameters where rates of routine monitoring exceeded 50% were measurement of blood pressure and triglyceride levels.…”

Section: Monitoring Cardiovascular Health and Metabolic Syndrome In Imentioning

confidence: 99%

“…Computerised systems have been shown to improve patient monitoring. 21 This should be complemented with effective collaboration between mental health and primary care services to promote integrated care. 25…”

Section: Monitoring Cardiovascular Health and Metabolic Syndrome In Imentioning

confidence: 99%

Physical Health and Drug Safety in Individuals with Schizophrenia

et al. 2017

View full text Add to dashboard Cite

Background: While antipsychotic medications are the mainstay of therapy for individuals with schizophrenia and psychotic disorders, their use is associated with adverse effects on physical health that require the attention and care of prescribers. Methods: We used the ADAPTE process to adapt existing guideline recommendations from the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the dosing of antipsychotics and antipsychotic polypharmacy, screening for adverse effects of antipsychotics, and management of metabolic and extrapyramidal side effects to the Canadian context. Results: Prescribers are encouraged to use the lowest effective dose and to avoid the routine use of multiple antipsychotics. Scheduled monitoring of body mass index, waist circumference, blood pressure, glucose, lipids, prolactin, electrocardiograms, and extrapyramidal symptoms is recommended. Lifestyle interventions are recommended to mitigate antipsychotic-induced weight gain. Prescribers should follow Canadian guidelines on the treatment of obesity, dyslipidemia, and diabetes. Recommendations on antipsychotic drug choice are made for users particularly concerned about extrapyramidal symptoms. Conclusion: Careful monitoring and attention by prescribers may mitigate adverse effects associated with antipsychotic medications.

show abstract

Persistence of metabolic monitoring for psychiatry inpatients treated with second-generation antipsychotics utilizing a computer-based intervention

Cited by 11 publications

References 8 publications

The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review

The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review

The effect of a computerized best practice alert system in an outpatient setting on metabolic monitoring in patients on second‐generation antipsychotics

Physical Health and Drug Safety in Individuals with Schizophrenia

Contact Info

Product

Resources

About