Increasing provider efficacy on metabolic monitoring
Abstract
**Please note that the full text is embargoed** ABSTRACT: Background: Second-generation antipsychotics (SGAs), the mainstay of treatment for persons
with serious mental illnesses (SMI), have been linked to obesity and metabolic syndrome. There
is an urgent need for providers to adhere to clinically applicable guidelines for screening and
monitoring metabolic disturbances in this population.
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Methods: A randomized retrospective chart review of 60 patient records, one group pre-test data
without a comparison group was performed following initiation of SGAs, 6 months before the
intervention. This was repeated after a 3-month intervention which involved implementation of a
recommended schedule for metabolic monitoring. The intervention included provision of
monitoring equipment (weighing scales, blood pressure cuffs), repetitive communication using
reminders and prompts among all stakeholders, and embedding a collaborative milieu within the
team structure.
Results: There was significant improvement in provider adherence rate in screening and
monitoring of earmarked metabolic indices during initiation and ongoing use of SGA therapy.
There was a mean score of 2.07 and 4.58 in the pre and post-intervention stages, respectively.
Patients in the post-intervention period were more likely to have anthropometric measurements
of weight (BMI), blood pressure, and blood panels. This difference remained significant when
narrowed into individual indices that were monitored.
Conclusion: Implementation and use of a metabolic monitoring schedule in an outpatient
psychiatric clinic for patients treated with SGAs led to significant improvement in adherence
rates among psychiatric providers. However, rates remain invariably low, underlining a need for
focused strategies and collaborative approaches to further improve metabolic monitoring.