Community based psychiatric outpatient metabolic monitoring program for atypical antipsychotics.
详细信息
文摘
Objective: The objectives of this project were to increase a) rates of metabolic monitoring consistent with APA and ADA guidelines, and b) prescriber awareness of the metabolic status of 45 patients prescribed atypical antipsychotics AAs) in the community support program CSP) of an outpatient psychiatry clinic. Method: A pre-intervention chart audit determined the number of patients in the CSP who were prescribed AAs and the rate of completion of each metabolic parameter. The intervention took place over four months and required equipment provision, creation of a wall poster, staff training, tracking of patients, development of a metabolic monitoring document for each patient, and continuous status updates for prescribers. Post-intervention, a second chart audit determined the pre- versus post-percentage rates of completion and the statistical significance of each parameters changed percentage. Results: With the McNemar test, results showed significant increases in completion of each parameter p ＞ 0.001) including a) family histories pre 2.22%, post 93.33%)； b) body mass index BMI) pre 4.44%, post 97.77%)； c) blood pressure BP) pre 40%, post 97.78%)； d) waist circumference pre 0%, post 93.33%)； e) fasting blood glucose FBG) pre 31.11%, post 77.78%)； f) fasting lipid profiles FLP) pre 17.78%, post 73.33%)； g) complete metabolic profiles pre 0%, post 68.89%)； and h) prescriber awareness pre 0%, post 93.33%). Conclusions: Efforts to increase metabolic monitoring of CSP patients in a community-based setting were highly successful. Numerous barriers and facilitators were identified including a dedicated project lead, crucial and ongoing staff training, and adequate time allotment to the program. The benefits of such a program clearly outweighed the risks of not providing metabolic monitoring to patients prescribed AAs.