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Shin S, Moon S, Wang J, Choi YJ. Impact of institutional quality improvement initiatives on metabolic monitoring in mental disorder in patients treated with antipsychotics: A meta-analysis of intervention studies. J Glob Health 2024; 14:04074. [PMID: 38783701 PMCID: PMC11116930 DOI: 10.7189/jogh.14.04074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background Compliance with guidelines regarding monitoring of metabolic adverse effects induced by antipsychotics has been consistently low. We characterised and evaluated the quality of institutional quality improvement (QI) interventions designed to address disparities between guidelines and real-world practices. Furthermore, we assessed the impact of these interventions on the screening and management of metabolic risks for inpatients receiving treatment with antipsychotic medications. Methods We conducted a meta-analysis of institutional QI intervention studies aimed at improving antipsychotic-associated metabolic risk monitoring in hospitalised mental disease patients. Relevant studies were identified through searches conducted in the Embase and PubMed databases, as well as by reviewing previous reviews and meta-analyses. Quantitative analyses were performed, calculating odds ratios (ORs) and 95% confidence intervals (CIs) to assess the impact of QI programmes on guideline adherence in clinical practice. Results We identified 12 intervention studies (n = 10 128 and n = 2667 patients in the pre-and post-intervention groups, respectively) and included them in our meta-analysis. QI interventions demonstrated effectiveness in bridging the guideline-practice gap in monitoring antipsychotic-induced metabolic adverse effects, as supported by the ORs and 95% CIs for post-intervention monitoring of plasma glucose, lipids, and blood pressure (BP) vs the pre-intervention period being OR = 6.90 (95% CI = 1.51-31.48), OR = 5.39 (95% CI = 4.01-7.24), and OR = 4.81 (95% CI = 1.23-18.79), respectively. Only 33.3% (4/12) of studies reported screening rates for all four metabolic parameters (plasma glucose, lipids, weight/body mass index (BMI), and BP). The median rates for metabolic screening of plasma glucose, lipids, and BP increased from 51.0-80.0%, 28.7-66.7%, and 91.7-95.8%, respectively. Up to 66.7% (8/12) of intervention studies lacked follow-up measures to treat or manage identified risks in hospitalised psychiatric patients, such as patient referrals, prescription of medications, and switching of antipsychotics. The odds of monitoring weight/BMI and glucose were greatest when QI programmes involved the participation of multidisciplinary health care professionals and patients, yielding OR = 3.35 (95% CI = 2.45-4.59) and OR = 57.51 (95% CI = 24.11-137.21), respectively. Conclusions Institutional QI interventions were effective in enhancing monitoring practices in alignment with established guidelines for metabolic risk screening among hospitalised patients with mental disorders maintained on antipsychotic medications. Future institutional QI programmes should incorporate multidisciplinary strategies involving patient engagement and extend their focus beyond screening to incorporate follow-up risk management strategies once risks have been identified. Registration PROSPERO CRD42023452138.
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Affiliation(s)
- Sooyoung Shin
- Department of Biohealth Regulatory Science, Graduate School, Ajou University, Suwon, Republic of Korea
- Department of Pharmacy, College of Pharmacy, Ajou University, Suwon, Republic of Korea
- Research Institute of Pharmaceutical Science and Technology, Ajou University, Suwon, Republic of Korea
| | - Suhyeon Moon
- Department of Biohealth Regulatory Science, Graduate School, Ajou University, Suwon, Republic of Korea
| | - Jua Wang
- Department of Biohealth Regulatory Science, Graduate School, Ajou University, Suwon, Republic of Korea
| | - Yeo Jin Choi
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
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Al-Awad FA, Almutairi HA, Almutairi SA, Alessa OS, Alanazi SF, Alzain NM, Albakr DM, Alzahrani SI. Adherence to the monitoring of metabolic syndrome in patients receiving antipsychotics in outpatient clinics in Saudi Arabia. J Family Community Med 2024; 31:42-47. [PMID: 38406217 PMCID: PMC10883427 DOI: 10.4103/jfcm.jfcm_153_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/24/2023] [Accepted: 11/05/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Monitoring protocols have been developed because patients taking atypical antipsychotics are more prone to developing metabolic syndrome, which leads to possible increased mortality and morbidity. The aim of this study was to assess the degree of adherence to the recommendations of metabolic syndrome monitoring. MATERIALS AND METHODS This study was conducted in two large psychiatric facilities in the Eastern Province of Saudi Arabia. A retrospective analysis of the medical records of 350 patients taking antipsychotic medications was done, and an assessment was made of the frequency of metabolic monitoring at each of the intervals as suggested by the American Diabetes Association. Data was analyzed using SPSS; descriptive statistics. were computed and Chi-square test was used to determine statistical significance for association between categorical variable. RESULTS The mean age of the patients was 34.9 ± 18 years; 64.6% were males. Olanzapine was the most prescribed medication (43.7%, n = 153), followed by quetiapine (17.4%, n = 61). Only one-third of the patients (29.6%) completed all the baseline parameters. Documentation of baseline parameters was low for glucose level (38.9%), lipid panel (17.3%), weight (25.2%), and waist circumference (1.4%). Adherence to yearly monitoring was much lower than at baseline (mean percentage: 29.6% vs. 1.7%). Furthermore, 45% of the patients were classified as obese and 10% had metabolic comorbidity. CONCLUSION Individuals with mental illness who were taking antipsychotics did not undergo proper metabolic screening during antipsychotic treatment. Barriers to adherence to the monitoring guidelines should be examined and addressed. Giving assistance to practitioners to recall the required laboratory tests and vitals at certain intervals could help improve metabolic monitoring practices.
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Affiliation(s)
- Feras A. Al-Awad
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hussien A. Almutairi
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saad A. Almutairi
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Othman S. Alessa
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Salman F. Alanazi
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nasser M. Alzain
- Department of Psychiatry, Eradah Complex and Mental Health, Dammam, Saudi Arabia
| | - Dalal M. Albakr
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Safa I. Alzahrani
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Høgnason Mohr G, Barcella CA, Grand MK, Kriegbaum M, Siersma V, Hahn MK, Agarwal SM, Bakkedal C, Baandrup L, Knop FK, Andersen CL, Ebdrup BH. Management of dyslipidaemia in individuals with severe mental illness: a population-based study in the Greater Copenhagen Area. Ther Adv Psychopharmacol 2023; 13:20451253231211574. [PMID: 38022836 PMCID: PMC10656803 DOI: 10.1177/20451253231211574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Severe mental illness (SMI) is associated with increased cardiovascular risk. Dyslipidaemia is a potentially modifiable risk factor, which may be inadequately managed in patients with SMI. Objectives To assess management of dyslipidaemia in patients with SMI versus healthy controls (HCs) in 2005 and 2015. Design and methods Using Danish registers, we identified adult patients with SMI in the Greater Copenhagen Area (schizophrenia spectrum disorders or bipolar disorder) with ⩾1 general practitioner contact in the year before 2005 and 2015, respectively, and HCs without SMI matched on age and gender (1:5). Outcomes were lipid-profile measurements, presence of dyslipidaemia and redemption of lipid-lowering pharmacotherapy. Differences in outcomes between patients with SMI and controls were measured with multivariable logistic regression. Results We identified 7217 patients with SMI in 2005 and 9939 in 2015. After 10 years, patients went from having lower odds of lipid measurements to having higher odds of lipid measurements compared with HCs [odds ratio (OR)2005 0.70 (99% confidence interval (CI) 0.63-0.78) versus OR2015 1.34 (99% CI 1.24-1.44); p2005versus2015 < 0.01]. Patients had higher odds of dyslipidaemia during both years [OR2005 1.43 (99% CI 1.10-1.85) and OR2015 1.23 (99% CI 1.08-1.41)]. Patients went from having lower odds of receiving lipid-lowering pharmacotherapy to having higher odds of receiving lipid-lowering pharmacotherapy [OR2005 0.77 (99% CI 0.66-0.89) versus OR2015 1.37 (99% CI 1.24-1.51); p2005versus2015 < 0.01]. However, among persons at high cardiovascular risk, patients had lower odds of receiving lipid-lowering pharmacotherapy during both years, including subsets with previous acute coronary syndrome [OR2005 0.30 (99% CI 0.15-0.59) and OR2015 0.44 (99% CI 0.24-0.83)] and ischaemic stroke or transient ischaemic attack (TIA) [OR2005 0.43 (99% CI 0.26-0.69) and OR 2015 0.61 (99% CI 0.41-0.89)]. Conclusion These results imply an increased general awareness of managing dyslipidaemia among patients with SMI in the primary prophylaxis of cardiovascular disease. However, secondary prevention with lipid-lowering drugs in patients with SMI at high cardiovascular risk may be lacking.
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Affiliation(s)
- Grimur Høgnason Mohr
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej 41, 2600 Glostrup, Denmark
| | - Carlo Alberto Barcella
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, University of Copenhagen, Hellerup, Denmark
- Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Mia Klinten Grand
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margaret K. Hahn
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Catrine Bakkedal
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Baandrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Mental Health Centre Copenhagen, Bispebjerg-Gentofte, Copenhagen NV, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip Krag Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Christen Lykkegaard Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bjørn Hylsebeck Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Azfr Ali R, Jalal Z, Chandan JS, Subramanian A, Adderley NJ, Nirantharakumar K, Gokhale KM, Paudyal V. Cardiometabolic screening and monitoring in patients prescribed antipsychotic drugs in primary care: A population-based cohort study. Compr Psychiatry 2023; 127:152419. [PMID: 37717342 DOI: 10.1016/j.comppsych.2023.152419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND This study aimed to investigate the level of guideline adherence for cardiometabolic health monitoring for patients prescribed antipsychotic medicines in UK primary care. METHODS In this population-based retrospective open cohort study, we used dataset of patients from the IQVIA Medical Research Data (IMRD) database between 1st January 2003 to 31st December 2018. Clinical Read codes were used to identify a cohort of adult patients with a diagnosis of Schizophrenia and at least four prescriptions of an anti-psychotic medication within 12 months of diagnosis. We then extracted data in relation to monitoring of cardiometabolic parameters (body compositions, lipids, and glucose outcomes) at baseline, then at six weeks, 12 weeks, and then 12 months. The frequency of outcome monitoring was described using descriptive statistics. FINDINGS A total of 11,435 patients were eligible and of them (n = 9707; 84·8%) were prescribed second-generation antipsychotics (SGAs). Only a small portion of the cohort (≈2·0%) received complete monitoring (at time points) for certain outcomes. Just over half the patients (n = 6599, 52%) had evidence of any cardiometabolic baseline testing for any of the study outcomes and the high majority had at least one abnormal lab value at baseline (n = 4627, 96·7%). INTERPRETATION In UK primary care, cardiometabolic monitoring practices among patients prescribed antipsychotics remain suboptimal. There is a need to promote guideline adherence to prevent adverse outcomes in antipsychotic users.
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Affiliation(s)
- Ruba Azfr Ali
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; Clnical Pharmacy Department, Schoolof Pharmacy, Umm Al Qura University, Makkah, KSA
| | - Zahraa Jalal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Krishna M Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Vibhu Paudyal
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Xu L, Zimmermann M, Forkey H, Griffin J, Wilds C, Morgan WS, Byatt N, McNeal CJ. How to Mitigate Risk of Premature Cardiovascular Disease Among Children and Adolescents with Mental Health Conditions. Curr Atheroscler Rep 2022; 24:253-264. [PMID: 35320835 PMCID: PMC8940585 DOI: 10.1007/s11883-022-00998-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The goal of this article is to characterize the myriad of ways that children with mental health conditions can be at risk for premature cardiovascular disease (CVD) and various modalities to ameliorate this risk in childhood in order to improve the life course of these children. REVIEW FINDINGS Child and adolescent mental health conditions are a common yet underrecognized risk factor for premature CVD. The American Heart Association has recently included psychiatric conditions as a CVD risk factor (CVDRF) and the evidence linking childhood adversity to cardiometabolic disease. There are bidirectional and additive effects from the intrinsic emotional dysregulation and inflammatory changes from the mental health condition, the associations with risky health behaviors, and in some cases, metabolic side effects from pharmacotherapy. These pathways can be potentiated by toxic stress, a physiologic response to stressors from childhood adversity. Toxic stress is also associated with development of mental health conditions with epigenetic effects that can result in transgenerational inheritance of cardiometabolic risk. Exposure to toxic stress and mental health conditions in isolation sometimes compounded by pharmacotherapies used in treatment increase the risk of cardiometabolic diseases in childhood. The multiple pathways, which adversely influence cardiometabolic outcomes, encourage clinicians to consider strategies to mitigate these factors and justify the importance of early screening and treatment for CVDRFs. Mental health, health behaviors, and environmental factors co-occur and intersect in complex pathways that can increase CVD risk over the lifespan. Early detection and response can mitigate the risks associated with premature development of CVD.
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Affiliation(s)
- Lulu Xu
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Martha Zimmermann
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Heather Forkey
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Jessica Griffin
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Caitlin Wilds
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
- Boston Child Study Center, Boston, MA, 02116, USA
| | - Wynne S Morgan
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Nancy Byatt
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Catherine J McNeal
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Health, Temple, TX, 76508, USA.
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Minjon L, van den Ban E, Bazelier MT, Lalmohamed A, Egberts TC, Heerdink ER. Monitoring of Adverse Drug Reaction-Related Parameters in Children, Youth, and Young Adults Prescribed Antipsychotic Drugs by General Practitioners. J Child Adolesc Psychopharmacol 2022; 32:36-44. [PMID: 34619039 PMCID: PMC8884168 DOI: 10.1089/cap.2021.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The aim of the study was to assess monitoring of adverse drug reaction (ADR)-related parameters in children, youth, and young adults treated with second-generation antipsychotic drugs (SGAs) prescribed by general practitioners (GPs). Methods: This retrospective follow-up study included children, youth, and young adults aged 0 - 24 years, who had an initial prescription of an SGA recorded in the Clinical Practice Research Datalink between 2000 and 2017, and who were prescribed an SGA more than once for a duration of at least 6 months. It included an assessment of which ADR-related physical parameters (weight, height, body-mass index, waist circumference, pulse, blood pressure, and heart examination) and laboratory parameters (glucose, HbA1c, lipids, and prolactin) were monitored in children, youth, and young adults at least once every 6-month period, stratified by sex, age categories, and calendar years. Results: In total, 7006 patients were included and the mean duration of follow-up was 1.6 years. Monitoring frequencies of all parameters were below 25%. Blood pressure and weight were monitored in 23.6% and 23.4%, respectively, of all children, youth, and young adults during the first half year; waist circumference was monitored in 0.2%. Females were monitored more often than males, some differences between age categories were observed, and monitoring frequencies increased after 2000, but did not exceed 35% in any year. Conclusion: Monitoring frequencies of ADR-related parameters in children, youth, and young adults treated with SGAs prescribed by a GP were low. Monitoring in primary care should be improved to enable a better evaluation of the benefit-risk balance during antipsychotic drug therapy.
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Affiliation(s)
- Lenneke Minjon
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Els van den Ban
- Karakter Child and Adolescent Psychiatry, Zwolle, The Netherlands
| | - Marloes T. Bazelier
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Arief Lalmohamed
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Toine C.G. Egberts
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eibert R. Heerdink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Research Group Innovation of Pharmaceutical Care, University of Applied Sciences, Utrecht, The Netherlands.,Address correspondence to: Eibert R. Heerdink, PhD, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, Utrecht 3508 TB, The Netherlands
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Tan XW, Chan CYW, Lum AWM, Lee ES, Mok YM, Fung DSS, Tor PC. Association of cardiovascular metabolic risk factor measurements with psychiatric readmission among in-hospital patients with severe mental illness: a retrospective study. BMC Psychiatry 2022; 22:43. [PMID: 35042498 PMCID: PMC8767705 DOI: 10.1186/s12888-022-03704-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI) and comorbid physical conditions were often associated with higher risks of mortality and hospital readmission. In this study, we aim to examine the association of cardiovascular metabolic risk factor measurements with risks of psychiatric readmissions among in-hospital patients with severe mental illness (SMI). METHODS We collected the longitudinal information of laboratory investigations, blood pressure and body mass index (BMI) among in-hospital patients who had been diagnosed with schizophrenia, major depression disorder or bipolar disorder and with comorbid diagnosis of hypertension, hyperlipidemia or diabetes from Jan 2014 to Jan 2019. The primary outcome was time to first psychiatric readmission. Cox proportional hazard model was utilized to calculate the hazard risks (HR) of cardiovascular metabolic risk factors with psychiatric readmission. RESULTS A total of 5,256 patients were included in the analysis. Compared to patients with normal blood parameters, patients with aberrant tests of high-density dyslipidemia (HDL) and diastolic blood pressure (DBP) during in-hospitalization period were associated with higher risks to first psychiatric readmission [ HR (Hazard Ratio), 1.37 95% Confidence interval (CI), 1.03-1.83 for HDL and HR, 1.32 (95% CI, 1.04-1.67])for DBP]. Compared to patients with optimal monitoring, patients with suboptimal monitoring of blood lipids and blood pressure during in-hospitalization period or recommended window period of cardiovascular disease (CVD) risk management were associated with higher risks to first psychiatric readmission. CONCLUSIONS Aberrant cardiovascular metabolic blood test and blood pressure and missing measurements among in-hospital patients with SMI were associated with increased risks of psychiatric readmissions. This calls for more active screening and monitoring of CVD risk factors for those in-hospital patients in need.
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Affiliation(s)
- Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Christopher Yi Wen Chan
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Alvin Wai Mum Lum
- grid.414752.10000 0004 0469 9592Medical Care Service, Institute of Mental Health, Singapore, 539747 Singapore
| | - Eng Sing Lee
- grid.466910.c0000 0004 0451 6215Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, 138543 Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, Singapore, 308232 Singapore
| | - Yee Ming Mok
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Graduate Medical School, Singapore, 169857 Singapore
| | - Daniel Shuen Sheng Fung
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, Singapore, 308232 Singapore
| | - Phern Chern Tor
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Graduate Medical School, Singapore, 169857 Singapore
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Dal Pan GJ. The Use of Real-World Data to Assess the Impact of Safety-Related Regulatory Interventions. Clin Pharmacol Ther 2021; 111:98-107. [PMID: 34699061 DOI: 10.1002/cpt.2464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 10/06/2021] [Indexed: 11/05/2022]
Abstract
The regulation of medicines seeks to ensure the efficacy, safety, and quality of prescription and non-prescription medicines. Given that the conditions under which a medicine's benefits outweigh its risks are complex, it is essential that communications about the safe and effective use of medicines be clear and actionable. Assessing the impact of interventions to improve the safe and effective use of medicines is a developing area, and one in which real-world data are playing an increasingly important role. Although real-world data are commonly used to assess the impact of regulatory interventions, there are several areas where their use could be improved. Specific areas for improvement include assessing regulatory interventions across a wider range of medicines, rather than concentrating on a relatively few therapeutic areas; assessing more clinically relevant outcomes rather than relying on measures such as changes in the number of prescriptions, which may not always correlate with the desired impact; assessing the potential unintended or negative consequences of regulatory interventions; applying methods to address potential confounders; assessing long-term, rather than just short-term, impacts of an intervention; increasing the use of comparator groups, when feasible; and evaluating the impact of regulatory interventions from multiple dimensions, rather than from a single dimension. Expanded use of real-world data could inform some of these efforts, although data sources beyond administrative claims data will likely be necessary to achieve all these goals.
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Affiliation(s)
- Gerald J Dal Pan
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Testing the Use of Data Drawn from the Electronic Health Record to Compare Quality. Pediatr Qual Saf 2021; 6:e432. [PMID: 34345748 PMCID: PMC8322494 DOI: 10.1097/pq9.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/10/2021] [Indexed: 11/01/2022] Open
Abstract
Introduction Health systems spend $1.5 billion annually reporting data on quality, but efficacy and utility for benchmarking are limited due, in part, to limitations of data sources. Our objective was to implement and evaluate measures of pediatric quality for three conditions using electronic health record (EHR)-derived data. Methods PCORnet networks standardized EHR-derived data to a common data model. In 13 health systems from 2 networks for 2015, we implemented the National Quality Forum measures: % children with sickle cell anemia who received a transcranial Doppler; % children on antipsychotics who had metabolic screening; and % pediatric acute otitis media with amoxicillin prescribed. Manual chart review assessed measure accuracy. Results Only 39% (N = 2,923) of 7,278 children on antipsychotics received metabolic screening (range: 20%-54%). If the measure indicated screening was performed, the chart agreed 88% of the time [95% confidence interval (CI): 81%-94%]; if it indicated screening was not done, the chart agreed 86% (95% CI: 78%-93%). Only 69% (N = 793) of 1,144 children received transcranial Doppler screening (range across sites: 49%-88%). If the measure indicated screening was performed, the chart agreed 98% of the time (95% CI: 94%-100%); if it indicated screening was not performed, the chart agreed 89% (95% CI: 82%-95%). For acute otitis media, chart review identified many qualifying cases missed by the National Quality Forum measure, which excluded a common diagnostic code. Conclusions Measures of healthcare quality developed using EHR-derived data were valid and identified wide variation among network sites. This data can facilitate the identification and spread of best practices.
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Davis DW, Lohr WD, Feygin Y, Creel L, Jawad K, Jones VF, Williams PG, Le J, Trace M, Pasquenza N. High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid. BMC Psychiatry 2021; 21:303. [PMID: 34112146 PMCID: PMC8194140 DOI: 10.1186/s12888-021-03309-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of antipsychotic medication and psychotropic polypharmacy has increased in the United States over the last two decades especially for children from low-income families and those in foster care. Although attention has been paid to providing greater insight, prescribing patterns remain concerning since there is a lack of evidence related to safety and efficacy. High-level psychotropic polypharmacy has not been described. We aim to compare the use of HLPP for children receiving Medicaid services and those in foster care and identify factors associated with the duration of use of high-level psychotropic polypharmacy. Additionally, we will examine the frequency of laboratory metabolic screening and emergency department, inpatient, and outpatient visits. METHODS A cross-sectional, secondary analysis of statewide data describes trends in high-level psychotropic polypharmacy from 2012 to 2017 and the prevalence and predictors of high-level psychotropic polypharmacy duration and resource use in 2017 for all children on Medicaid and those in foster care. High-level psychotropic polypharmacy included concurrent use, at least four classes of medications including an antipsychotic, and at least 30 days duration. RESULTS High-level psychotropic polypharmacy increased from 2012 to 2014 for both groups but stabilized in 2015-2016. Children in foster care showed a slight increase compared to their peers in 2017. There was no association between duration and demographic characteristics or foster care status. Diagnoses predicted duration. Neither group received metabolic monitoring at an acceptable rate. CONCLUSIONS Concerning patterns of high-level psychotropic polypharmacy and metabolic monitoring were identified. Cautious use of high-level psychotropic polypharmacy and greater oversight to ensure that these children are receiving comprehensive services like behavioral health, primary care, and primary prevention.
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Affiliation(s)
- Deborah Winders Davis
- Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY, 40202, Louisville, USA.
| | - W. David Lohr
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Yana Feygin
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Liza Creel
- grid.266623.50000 0001 2113 1622Department of Health Management & System Sciences, University of Louisville School of Public Health and Information Science, 485 E. Gray Street, Louisville, KY 40202 USA
| | - Kahir Jawad
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - V. Faye Jones
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - P. Gail Williams
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Jennifer Le
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Marie Trace
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
| | - Natalie Pasquenza
- grid.266623.50000 0001 2113 1622Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit, University of Louisville, 571 S. Floyd Street, KY 40202 Louisville, USA
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11
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Lambert C, Panagiotopoulos C, Davidson J, Goldman RD. Second-Generation Antipsychotic Use in Pediatric Emergency Medicine. Pediatr Emerg Care 2021; 37:161-164. [PMID: 33651760 DOI: 10.1097/pec.0000000000002387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In recent years, the number of patients presenting to the emergency department with mental health complaints has been growing, alongside an increase in second-generation antipsychotic (SGAs) prescriptions for a variety of mental health conditions. Children treated with SGAs may have abnormalities, such as rapid weight gain and central adiposity, glucose intolerance, dyslipidemia, and hypertension; they may present to the pediatric emergency department with components of metabolic syndrome or type 2 diabetes, and a subsequent significant risk for cardiovascular complications later in life. Pediatric emergency department providers may serve as a safety net for patients to detect SGA-related metabolic complications, especially among vulnerable populations lacking access to primary care or psychiatric services.
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Affiliation(s)
- Clare Lambert
- From the Trainee, The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine
| | | | | | - Ran D Goldman
- Professor, The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, University of British Columbia; BC Children's Hospital Research Institute, Vancouver, BC, Canada
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12
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Haussleiter I, Emons B, Hoffmann K, Juckel G. The somatic care situation of people with mental illness. Health Sci Rep 2021; 4:e226. [PMID: 33364443 PMCID: PMC7752157 DOI: 10.1002/hsr2.226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/04/2020] [Accepted: 12/06/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND AIMS People with mental illness have worse physical health and reduced life expectancy compared to the general population. Nevertheless, their medical care is often insufficient. The present study aimed to investigate the somatic status of people with mental illness with a focus on somatic diagnoses, metabolic risk factors, regular somatic care, and routine check-ups. METHODS This study used a 14-item questionnaire to survey the somatic care situation of psychiatric university hospital patients. Main survey topics were psychiatric and somatic diagnoses, metabolic risk factors, regular somatic care, and routine check-ups. RESULTS Four-hundred and thirty-five people with mental illness (48.3% male, mean age 45.4 years) were included. More than three quarters of the participating people with mental illness had access to a general practitioner. People with affective and anxiety disorders reported significantly more contact with medical specialists for somatic diseases, but schizophrenic patients did not receive enough care. Not all people with mental illness and on psychiatric medication received regular somatic care. Somatic diseases increased with number of diagnoses, and the duration of the psychiatric illness was positively correlated with treatment motivation. CONCLUSION The observed unmet medical needs in this study might reflect the lack of treatment motivation in people with mental illness, but could also represent their obstacles to access care as well as a suboptimal communication between the treating psychiatrist and the referring general practitioner. Increasing awareness of somatic diseases in psychiatric patients and easier access to somatic care have to be implemented in psychiatric clinical routine. The risk of stigmatization in somatic institutions and the lack of self-care management in people with mental illness are complicating factors.
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Affiliation(s)
- Ida Haussleiter
- Department of Psychiatry, LWL‐Institute of Mental HealthRuhr University BochumBochumGermany
- Department of Psychiatry, LWL University Hospital BochumRuhr University BochumBochumGermany
| | - Barbara Emons
- Department of Psychiatry, LWL‐Institute of Mental HealthRuhr University BochumBochumGermany
| | - Knut Hoffmann
- Department of Psychiatry, LWL‐Institute of Mental HealthRuhr University BochumBochumGermany
- Department of Psychiatry, LWL University Hospital BochumRuhr University BochumBochumGermany
| | - Georg Juckel
- Department of Psychiatry, LWL‐Institute of Mental HealthRuhr University BochumBochumGermany
- Department of Psychiatry, LWL University Hospital BochumRuhr University BochumBochumGermany
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13
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Kara I, Penner M. Impact of Antipsychotic Guidelines on Laboratory Monitoring in Children with Neurodevelopmental Disorders. J Child Adolesc Psychopharmacol 2021; 31:79-83. [PMID: 33052712 PMCID: PMC7891197 DOI: 10.1089/cap.2020.0096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) guidelines provide monitoring recommendations for children who are treated with second-generation antipsychotics (SGAs). The objective of this study was to determine the impact of the CAMESA guidelines on SGA monitoring in children with neurodevelopmental disorders. Methods: A retrospective chart review compared laboratory monitoring in children treated with SGAs who were referred to a tertiary psychopharmacology clinic before (2008-2011) and after (2013-2016) CAMESA publication. Chi-squared tests were used to detect changes in SGA use and monitoring between the two time periods. Results: A total of 345 charts were reviewed (n = 136 pre-CAMESA, n = 209 post-CAMESA). The proportion of children taking an SGA increased significantly (35% vs. 49%; p = 0.02) as did the duration of SGA treatment before tertiary assessment (18.6 months vs. 27.2 months; p = 0.03). SGA monitoring data were missing in 40% of charts pre-CAMESA and in 31% of charts post-CAMESA. The proportion of patients with any available laboratory monitoring did not change between the time periods (35% pre-CAMESA vs. 39% post-CAMESA; p = 0.56). Similarly, the proportion of patients with full laboratory monitoring was not significantly different between time periods (15% pre-CAMESA vs. 25% post-CAMESA; p = 0.23). Conclusions: SGA monitoring rates did not significantly improve after CAMESA guideline publication. To maximize benefit and mitigate risks of these medications, there is a need to identify barriers to SGA monitoring.
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Affiliation(s)
- Imaan Kara
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Melanie Penner
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Address correspondence to: Melanie Penner, MD, MSc, FRCP(C), Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, Ontario M4G 1R8, Canada
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14
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Iturralde E, Slama N, Kline-Simon AH, Young-Wolff KC, Mordecai D, Sterling SA. Premature mortality associated with severe mental illness or substance use disorder in an integrated health care system. Gen Hosp Psychiatry 2021; 68:1-6. [PMID: 33227668 DOI: 10.1016/j.genhosppsych.2020.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/20/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Research has reported shortened lifespans (by 15-30 years) for those with severe mental illness (SMI) or substance use disorder (SUD), particularly among public mental health treatment consumers. We assessed SMI- and SUD-associated mortality in the understudied setting of a large, nonprofit integrated health care system. METHOD This retrospective cohort study examined 2010-2017 health system and death records for 564,592 adult patients. Half had SMI/SUD diagnosis; half were a demographically matched comparison group without SMI, other mental health, or SUD diagnoses. We estimated mortality risks, adjusting for demographic and physical health factors. RESULTS Having SMI or SUD was associated with higher odds of death (adjusted odds ratio = 1.87) and an average 6.3 years of earlier death relative to comparison individuals. Co-occurring SMI and SUD conferred higher mortality risk from major natural and unnatural causes than did SMI with no SUD. CONCLUSIONS Some indicators of premature mortality were lower than those reported for U.S. public mental health consumers, but risk level varied widely by diagnosis. While patients' having insurance and broad access to care may lower risk, access to care may be insufficient to overcome the many patient-, provider-, and system-level factors contributing to poor physical health in SMI and SUD.
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Affiliation(s)
- Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Natalie Slama
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Don Mordecai
- The Permanente Medical Group, Kaiser Permanente Northern California, 1950 Franklin Street, Oakland, CA 94612, United States of America
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States of America
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15
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Bulteau S, Le Pierres M, Artarit P, Forestier B, Michaud E, Chaslerie A, Bonnot O, Victorri-Vigneau C. Advocacy for better metabolic monitoring after antipsychotic initiation: based on data from a French health insurance database. Expert Opin Drug Saf 2020; 20:225-233. [PMID: 33225754 DOI: 10.1080/14740338.2021.1851678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Nearly 3% of the population is treated by antipsychotic. The aim of this study was to assess the conformity of monitoring with guidelines to prevent Metabolic Syndrome. Research design and method: The analysis was conducted using SNIIRAM data (2013 to 2017) on a cohort of patients who received at least eight antipsychotic dispensings in the first year. Glucose and lipid testings were recorded according to refunds at initiation [between -3 and 0.5 months], 3 months [between 2 and 4 months], and 12 months [between 11 and 13 months] after, and assuming optimal testing during hospitalization (exclusive of psychiatric unit). Descriptive and comparative analysis, «chi-squared test or Student's t-test», were performed as well as multivariate analysis with logistic regression. Results: 18 760 patients were selected, 14 421 were still alive and monitored at the end of the follow up. In the recommended period, only 2.89% of patients had three complete testings and 50.6% one or two complete testings Non-optimal testing was more likely to occur in children and adults (vs elderly), in patients with less than 3 prescribers, and with universal medical coverage. Conclusion: Monitoring remains dramatically insufficient. New actions involving patients, practitioners, and authorities are warranted.
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Affiliation(s)
- Samuel Bulteau
- CHU de Nantes, Addictology and Liaison-Psychiatry Department, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University , Nantes, France
| | | | - Pascal Artarit
- Medical Department, French Health Insurance, Pays-de-la-Loire, Nantes, France
| | - Bastien Forestier
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University , Nantes, France.,CHU De Nantes, Public Health Department, Nantes, France
| | - Emmanuelle Michaud
- Medical Department, French Health Insurance, Pays-de-la-Loire, Nantes, France
| | - Anicet Chaslerie
- Medical Department, French Health Insurance, Pays-de-la-Loire, Nantes, France
| | - Olivier Bonnot
- CHU De Nantes, Department of Child and Adolescent Psychiatry, Nantes, France
| | - Caroline Victorri-Vigneau
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University , Nantes, France.,CHU De Nantes, Clinical Pharmacology Department, Nantes, France
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16
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Ali RA, Jalal Z, Paudyal V. Barriers to monitoring and management of cardiovascular and metabolic health of patients prescribed antipsychotic drugs: a systematic review. BMC Psychiatry 2020; 20:581. [PMID: 33276762 PMCID: PMC7718699 DOI: 10.1186/s12888-020-02990-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The use of atypical antipsychotics which currently form the primary choice pharmacotherapy for several mental health conditions have been linked to cardiovascular and metabolic side effects. This systematic review aimed to investigate the barriers to monitoring and management of cardiovascular co-morbidities in patients prescribed antipsychotic medicines. METHODS A protocol-led (CRD-42018106002) systematic literature review was conducted by searching Medline, Embase, and PsycINFO databases 2003 until October 2019. Cochrane, Centre for Review and Dissemination (CRD) and PRISMA guidelines were followed. Studies investigating barriers to monitoring and management of cardiovascular co-morbidities in patients prescribed antipsychotic medicines were included. RESULTS A total of 23 records were included. Key barriers included a) health-care system-related factors such as lack of knowledge and expertise amongst care providers, available resources, confusion around remit and roles, fragmentation of care such as across general practitioners and psychiatrists, and time constraints and b) patient-related factors such as disability resulting from mental health conditions, knowledge and skills of the patients. CONCLUSION Barriers to monitoring and management of cardiovascular and metabolic health of patients taking antipsychotic medicines are multidimensional. Apart from educational interventions directed to both patients and health-care professionals, the results suggest a need for the improvement of wider system-related factors to improve physical health of patients prescribed antipsychotic medicines. Clearer guidelines, clarity of remit and roles amongst service providers are necessary in addition to educational interventions directed at patients and health-care professionals in improving physical health monitoring, counselling and management of patients prescribed antipsychotic medicines. TRIAL REGISTRATION A protocol was developed and registered with PROSPERO as per PRISMA-P guidelines ( CRD 42018106002 ).
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Affiliation(s)
- Ruba Azfr Ali
- School of Pharmacy, University of Birmingham, Birmingham, UK
- Clinical Pharmacy Department, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Zahraa Jalal
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Vibhu Paudyal
- School of Pharmacy, University of Birmingham, Birmingham, UK.
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17
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Hamilton C, Taylor J, Mambourg S. Evaluation of Metabolic Monitoring and Diabetes Incidence in the First Year for Veterans Newly Started on an Atypical Antipsychotic. Fed Pract 2020; 37:532-535. [PMID: 33328720 PMCID: PMC7735454 DOI: 10.12788/fp.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE This retrospective chart review is an evaluation of patient and health care provider adherence to a metabolic monitoring protocol as well as progression to type 2 diabetes mellitus (T2DM) in the first year after atypical antipsychotic initiation. METHODS Patient (N = 1,651) data from February 2014 to February 2019 were collected from the US Department of Veterans Affairs (VA) Corporate Data Warehouse for 8 VA medical centers within Veterans Integrated Service Network (VISN) 21. Collected data included patient demographic, laboratory results, and medication history. RESULTS In the final cohort, 6% of patients were found to have progressed to T2DM. Adherence to appropriate metabolic monitoring was found to be overall suboptimal. CONCLUSIONS The findings of this project demonstrate that patients in VISN 21 who were previously antipsychotic-naïve and nondiabetic may be at increased risk of progression to T2DM when compared with the general population. To effectively manage patient risk, health care providers and patients should improve adherence to metabolic monitoring.
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Affiliation(s)
- Clayton Hamilton
- is an Informatics Pharmacist at the George E. Wahlen Medical Center in Salt Lake City, Utah. is the Veterans Integrated Service Network (VISN) 21 Pharmacy Benefits Management office Program and Data Manager, and is the VISN 21 Pharmacy Executive, both in Reno, Nevada
| | - Janice Taylor
- is an Informatics Pharmacist at the George E. Wahlen Medical Center in Salt Lake City, Utah. is the Veterans Integrated Service Network (VISN) 21 Pharmacy Benefits Management office Program and Data Manager, and is the VISN 21 Pharmacy Executive, both in Reno, Nevada
| | - Scott Mambourg
- is an Informatics Pharmacist at the George E. Wahlen Medical Center in Salt Lake City, Utah. is the Veterans Integrated Service Network (VISN) 21 Pharmacy Benefits Management office Program and Data Manager, and is the VISN 21 Pharmacy Executive, both in Reno, Nevada
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18
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Højer MMG, De Bruin ML, Boskovic A, Hallgreen CE. Are monitoring instructions provided in direct healthcare professional communications (DHPCs) of sufficient quality? A retrospective analysis of DHPCs sent out between 2007 and 2018. BMJ Open 2020; 10:e036498. [PMID: 32398337 PMCID: PMC7223281 DOI: 10.1136/bmjopen-2019-036498] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess whether direct to healthcare professional communications (DHPCs) are of sufficient quality to be applicable in clinical practice and study how the quality differs according to safety concerns and type of monitoring. DESIGN Retrospective cohort study. SETTING DHPCs containing monitoring instructions were identified among all DHPC issued in Denmark between 2007 and 2018. INTERVENTION Quality of information of monitoring instructions was assessed according to the Systematic Information for Monitoring (SIM) score. Associations between different characteristics of instructions and the SIM score were compared with analysis of variance and the post hoc test Tukey's honestly significant difference if significant. RESULTS In total, 297 DHPCs were issued, of which 97 contained 134 monitoring instructions. For 95% of these DHPCs the European Medicines Agency was involved. The average SIM score was 2.6±1.6 (ranging 0-6) and only 47% were considered of sufficient quality (SIM score ≥3). In addition, even fewer (11%) instructions were considered a 'adequate instruction' which also reported about facts and risks. Differences between quality of information according to type of monitoring were observed, specifically between clinical monitoring (average SIM score 1.9) and biomarker monitoring (physical average SIM score 2.9, p=0.029 and laboratory average SIM score 3.4, p<0.0001). CONCLUSIONS Monitoring instructions were found not to be of sufficient quality to be applicable in clinical practice according to the SIM score. Our study concludes the need for further research and regulatory steps to ensure improve quality of information in safety communications.
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Affiliation(s)
- Maja-Marie Grønfeldt Højer
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Marie Louise De Bruin
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Arnela Boskovic
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Christine Erikstrup Hallgreen
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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19
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Correll C. From receptor pharmacology to improved outcomes: individualising the selection, dosing, and switching of antipsychotics. Eur Psychiatry 2020; 25 Suppl 2:S12-21. [DOI: 10.1016/s0924-9338(10)71701-6] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AbstractDeterminants of antipsychotic selection and response include parameters of the primary disorder, psychiatric and physical comorbidities, past treatment effects, patient preferences, availability and acceptability of different treatments and formulations, as well as expected efficacy and safety. In the absence of consistent and sufficiently large efficacy differences among antipsychotics (except for clozapine in refractory patients), and in view of a greater focus on physical health, functional outcomes and quality of life, relatively more predictable differences in adverse events have become an important management consideration. Treatments are often selected because of a relatively lower propensity for extrapyramidal and sexual side effects, sedation, and, especially, the reduced development of cardiometabolic risk states and disorders. In this context, differences in receptor binding affinity, intrinsic activity and in the half life of antipsychotics are crucial to adopt adequate dosing and switching strategies. Dopamine rebound phenomena can occur when the level of dopamine blockade is not kept relatively constant during the switch process. This can happen when the new antipsychotic is underdosed or not fully absorbed, the switch is too abrupt from an antipsychotic with a short half life to one with a much longer half life, or when a dopamine antagonist is switched too fast to an antipsychotic with markedly less dopamine affinity or to a partial dopamine agonist. Intra-switch destabilization can also occur when changing too quickly from antipsychotics with strong histaminergic and/or cholinergic blockade to ones with lower affinity to these receptors. Overlapping “plateau” switch strategies and transient co-treatment with calming medications, such as benzodiazepines, have emerged as potential solutions to these rebound phenomena that can complicate the early switch period. To optimize outcomes, antipsychotic treatment should be pharmacologically informed and measurement based, combining both acute and long-term management goals and balancing efficacy and adverse effect considerations.
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20
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Mackin P, Waton T, Watkinson H, Gallagher P. A four-year naturalistic prospective study of cardiometabolic disease in antipsychotic-treated patients. Eur Psychiatry 2020; 27:50-5. [DOI: 10.1016/j.eurpsy.2010.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/25/2010] [Accepted: 08/31/2010] [Indexed: 02/02/2023] Open
Abstract
AbstractThe relationship between antipsychotic use and cardiovascular morbidity and mortality is controversial. There is a lack of long-term prospective studies investigating changes in cardiometabolic risk in patients treated with antipsychotic drugs. We report data from a 4-year prospective study. Patients (89) underwent detailed metabolic and cardiovascular risk assessment at 4-years which included anthropometric assessment, blood pressure, lipid profile, and an oral glucose tolerance test. We used the homeostatic model assessment to determine insulin resistance, and calculated 10-year cardiovascular risk scores. Mean age of subjects was 44.7 (±11.5) years, and 52% were male. The prevalence of type 2 diabetes was 8%, and 38.4% fulfilled diagnostic criteria for the metabolic syndrome. With the exception of increased central adiposity over the 4-year follow-up period (p < 0.001), other cardiometabolic parameters were generally unchanged. There was a high prevalence of dyslipidaemia, but only 16.9% were prescribed lipid-lowering treatment. Commencing lipid-lowering therapy was associated with a reduction in cardiovascular risk score (OR 7.9, 95% CI = 1.3 to 48.7; p = 0.02). Patients established on longer-term antipsychotic treatment show less dramatic metabolic changes than those occurring in the early stages of treatment, but have a high burden of cardiovascular risk. Lipid-lowering therapy is associated with a significant reduction in cardiovascular risk.
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21
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Georgi U, Lämmel J, Datzmann T, Schmitt J, Deckert S. Do drug-related safety warnings have the expected impact on drug therapy? A systematic review. Pharmacoepidemiol Drug Saf 2020; 29:229-251. [PMID: 32045502 DOI: 10.1002/pds.4968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/22/2019] [Accepted: 01/28/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The need for drug-related safety warnings is undisputed, and their impact should also be evaluated. This systematic review investigates and assesses the impact of safety warnings on drug therapy. METHODS Studies published in English between January 1998 and December 2018 were searched in EMBASE and MEDLINE, complemented by manual search. Randomised controlled trials, cohort studies with a before/after component, and case-control studies were included, selected to predefined criteria, and assessed for their reporting and methodological quality. RESULTS Out of 7454 references identified, 72 studies were included. A total of 28/72 (39%) studies described the impact of safety warnings on drug therapy as being effective, whereas 12/72 (17%) studies did not. Further, 26/72 (36%) studies described a partial implementation of the warnings (one part of the warning had an impact on drug therapy and another did not). Unintended effects were investigated in 6/72 (8%) studies. While 34 (47%) studies examined safety warnings on psychotropic drugs using an interrupted time series (ITS) design (53%), a before/after (26%), and a time series design (21%), 38 (53%) studied other substances using an ITS design (34%), a before/after (40%), and a time series design (26%). The proportion of an effective impact on drug therapy was lower in the "psychotropic drugs" group (23%) than in the "others" group (53%). CONCLUSION Drug-related safety warnings induce intended and unintended effects. The included studies are of broadly varying methodological quality. To better compare their effectiveness, studies should be conducted using standardised procedures.
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Affiliation(s)
- Ulrike Georgi
- Pharmacy Service of Clinical Center, Chemnitz, Germany.,Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Julia Lämmel
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.,Pharmacy Service, Medical Center of the Carl Gustav Carus Technical University, Dresden, Germany
| | - Thomas Datzmann
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center for Tumor Diseases, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Stefanie Deckert
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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22
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Taipale H, Tanskanen A, Mehtälä J, Vattulainen P, Correll CU, Tiihonen J. 20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20). World Psychiatry 2020; 19:61-68. [PMID: 31922669 PMCID: PMC6953552 DOI: 10.1002/wps.20699] [Citation(s) in RCA: 199] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Antipsychotics are effective in preventing relapses of schizophrenia, but it is generally believed that their long-term use is harmful for patients' physical well-being. However, there are no long-term studies which have verified this view. This nationwide, register-based cohort study aimed to assess the risk of hospitalization due to physical health problems, as a marker for severe physical morbidity, and the risk of all-cause mortality, as well as of cardiovascular and suicidal death, associated with antipsychotic use in all patients treated for schizophrenia in inpatient care between 1972 and 2014 in Finland (N=62,250), with up to 20 years of follow-up (median: 14.1 years). The use of antipsychotic drugs (i.e., use of any antipsychotic compared with non-use) and the use of specific antipsychotics were investigated, and outcomes were somatic and cardiovascular hospitalization, and all-cause, cardiovascular and suicide death. Hospitalization-based outcomes were analyzed by a within-individual design to eliminate selection bias, comparing use and non-use periods in the same individual by stratified Cox model. Mortality outcomes were assessed by traditional between-individual Cox multivariate models. The adjusted hazard ratios (aHRs) for any somatic hospitalization and cardiovascular hospitalization were 1.00 (95% CI: 0.98-1.03) and 1.00 (95% CI: 0.92-1.07) during use of any antipsychotic compared to non-exposure periods within the same individual. The aHRs were 0.48 (95% CI: 0.46-0.51) for all-cause mortality, 0.62 (95% CI: 0.57-0.67) for cardiovascular mortality, and 0.52 (95% CI: 0.43-0.62) for suicide mortality during use vs. non-use of any antipsychotic. The most beneficial mortality outcome was associated with use of clozapine in terms of all-cause (aHR=0.39, 95% CI: 0.36-0.43), cardiovascular (aHR=0.55, 95% CI: 0.47-0.64) and suicide mortality (aHR=0.21, 95% CI: 0.15-0.29). The cumulative mortality rates during maximum follow-up of 20 years were 46.2% for no antipsychotic use, 25.7% for any antipsychotic use, and 15.6% for clozapine use. These data suggest that long-term antipsychotic use does not increase severe physical morbidity leading to hospitalization, and is associated with substantially decreased mortality, especially among patients treated with clozapine.
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Affiliation(s)
- Heidi Taipale
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland,School of Pharmacy, University of Eastern Finland, KuopioFinland
| | - Antti Tanskanen
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland,Public Health Evaluation and Projection Unit, National Institute for Health and WelfareHelsinkiFinland
| | | | | | - Christoph U. Correll
- Department of Psychiatry, Zucker Hillside HospitalNorthwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Center for Psychiatric Neuroscience, Feinstein Institute for Medical ResearchManhassetNYUSA,Department of Child and Adolescent PsychiatryCharité UniversitätsmedizinBerlinGermany
| | - Jari Tiihonen
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland,Center for Psychiatry Research, Stockholm City CouncilStockholmSweden
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23
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Padmanabhan J. The value of family history in screening for type 2 diabetes comorbidity. Schizophr Res 2020; 216:12-13. [PMID: 32005563 DOI: 10.1016/j.schres.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/18/2020] [Accepted: 01/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jaya Padmanabhan
- Takeda Pharmaceuticals, 40 Landsdowne St, Cambridge MA 02139, United States of America.
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24
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Mangurian C, Schillinger D, Newcomer JW, Vittinghoff E, Essock S, Zhu Z, Dyer W, Young-Wolff KC, Schmittdiel J. Comorbid Diabetes and Severe Mental Illness: Outcomes in an Integrated Health Care Delivery System. J Gen Intern Med 2020; 35:160-166. [PMID: 31705468 PMCID: PMC6957587 DOI: 10.1007/s11606-019-05489-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/02/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diabetes prevalence is twice as high among people with severe mental illness (SMI) when compared to the general population. Despite high prevalence, care outcomes are not well understood. OBJECTIVE To compare diabetes health outcomes received by people with and without comorbid SMI, and to understand demographic factors associated with poor diabetes control among those with SMI. DESIGN Retrospective cohort study PARTICIPANTS: 269,243 adults with diabetes MAIN MEASURES: Primary outcomes included optimal glycemic control (A1c < 7) or poor diabetes control (A1c > 9) in 2014. Secondary outcomes included control of other cardiometabolic risk factors (hypertension, dyslipidemia, smoking) and recommended diabetes monitoring. KEY RESULTS Among this cohort, people with SMI (N = 4,399), compared to those without SMI (N = 264,844), were more likely to have optimal glycemic control, adjusting for various covariates (adjusted relative risk (aRR) 1.25, 95% CI 1.21-1.28, p < .001) and less likely to have poor control (aRR 0.92, 95% CI 0.87-0.98, p = 0.012). Better blood pressure and lipid control was more prevalent among people with SMI when compared to those without SMI (aRR 1.03; 95% CI 1.02-1.05, p < .001; aRR 1.02; 95% CI 1.00-1.05, p = 0.044, respectively). No differences were observed in recommended A1c or LDL testing, but people with SMI were more likely to have blood pressure checked (aRR 1.02, 95% CI 1.02-1.03, p < .001) and less likely to receive retinopathy screening (aRR 0.80, 95% CI 0.71-0.91, p < .001) than those without SMI. Among people with diabetes and comorbid SMI, younger adults and Hispanics were more likely to have poor diabetes control. CONCLUSIONS Adults with diabetes and comorbid SMI had better cardiometabolic control than people with diabetes who did not have SMI, despite lower rates of retinopathy screening. Among those with comorbid SMI, younger adults and Hispanics were more vulnerable to poor A1c control.
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - Dean Schillinger
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - John W Newcomer
- Thriving Mind South Florida and Washington University School of Medicine, St Louis, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Essock
- Department of Psychiatry, Columbia University, New York City, NY, USA
| | - Zheng Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Wendy Dyer
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Kelly C Young-Wolff
- Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Julie Schmittdiel
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
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25
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Opinions of Primary Care Clinicians and Psychiatrists on Monitoring the Metabolic Effects of Antipsychotics. J Am Board Fam Med 2019; 32:418-423. [PMID: 31068407 PMCID: PMC7213492 DOI: 10.3122/jabfm.2019.03.180176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Although people with severe mental illness (SMI) have high rates of diabetes and other metabolic disorders, adherence to recommended screening guidelines is low. This study aimed to compare primary care clinicians' and psychiatrists' attitudes toward metabolic monitoring and treatment of patients with SMI. METHODS Primary care clinicians and psychiatrists within 1 large urban integrated public health system were recruited to participate in this online survey study. Multivariate logistic regression analyses were used to examine if clinician characteristics were associated with attitudes or perceived barriers toward metabolic monitoring and treatment. RESULTS Response rates were 77% (164/214) of primary care providers and 69% (56/81) of psychiatrists completing the survey. There were no significant differences in age or race/ethnicity between provider groups, although primary care clinicians were more likely to be women when compared with the psychiatrists (69% vs 39%, P < .001). Psychiatrists were more likely than primary care clinicians to believe that psychiatrists should conduct metabolic monitoring even if patients had a primary care provider (80% vs 60%, P = .011) However, fewer psychiatrists than primary care clinicians believed that psychiatrists should treat identified cardiometabolic abnormalities (15% vs 42%, P < .001). CONCLUSION Systemic problems with care coordination and these varying expectations likely contribute to poor cardiometabolic outcomes in this vulnerable population.
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26
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Simoons M, Ruhé HG, van Roon EN, Schoevers RA, Bruggeman R, Cath DC, Muis D, Arends J, Doornbos B, Mulder H. Design and methods of the 'monitoring outcomes of psychiatric pharmacotherapy' (MOPHAR) monitoring program - a study protocol. BMC Health Serv Res 2019; 19:125. [PMID: 30764821 PMCID: PMC6376699 DOI: 10.1186/s12913-019-3951-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 02/07/2019] [Indexed: 11/20/2022] Open
Abstract
Background At many outpatient departments for psychiatry worldwide, standardized monitoring of the safety of prescribed psychotropic drugs is not routinely performed in daily clinical practice. Therefore it is unclear to which extent the drugs used by psychiatric outpatients are prescribed effectively and safely. These issues warrant structured monitoring of medication use, (pre-existing) co-morbidities, effectiveness and side effects during psychiatric outpatient treatment. Improvement of monitoring practices provides an opportunity to ensure that somatic complications and adverse drug effects are detected and dealt with in a timely manner. Structural support for data collection and follow-up tests seems essential for improvement of monitoring practices in psychiatric outpatients. The implementation of a structured somatic monitoring program as part of routine clinical practice, as we describe in this study protocol, may be a solution. Methods In order to address these issues, we developed the innovative program ‘Monitoring Outcomes of Psychiatric Pharmacotherapy (MOPHAR)’. MOPHAR is an infrastructure for implementation of standardized routine outcome monitoring (ROM; including standardized monitoring of treatment effect), monitoring of adverse psychotropic medication effects in psychiatric outpatients, encompassing both somatic adverse effects (e.g. metabolic disturbances) and subjective adverse effects (e.g. sedation or sexual side effects) and medication reconciliation. Discussion In the MOPHAR monitoring program, a nurse performs general and psychotropic drug-specific somatic screenings and provides the treating mental health care providers with more and better information on somatic monitoring for treatment decisions. Given our experience regarding implementation of the MOPHAR program, we expect that the MOPHAR program is feasible and beneficial for patients in any MHS organisation. This paper describes the objectives, target population, setting and the composition and roles of the treatment team. It also indicates what measurements are performed at which time points during outpatient treatment in the MOPHAR monitoring program, as well as the research aspects of this project. Trial registration MOPHAR research has been prospectively registered with the Netherlands Trial Register on 19th of November 2014. (NL4779). Electronic supplementary material The online version of this article (10.1186/s12913-019-3951-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - Eric N van Roon
- Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands. .,Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, PO Box 888, 8901, BR, Leeuwarden, The Netherlands.
| | - Robert A Schoevers
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, University Centre for Psychiatry, Groningen, The Netherlands
| | - Daniëlle C Cath
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Diny Muis
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Johan Arends
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Bennard Doornbos
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
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27
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Monteleone P, Amore M, Cabassi A, Clerici M, Fagiolini A, Girardi P, Jannini EA, Maina G, Rossi A, Vita A, Siracusano A. Attitudes of Italian Psychiatrists Toward the Evaluation of Physical Comorbidities and Sexual Dysfunction in Patients With Schizophrenia. Implications for Clinical Practice. Front Psychiatry 2019; 10:842. [PMID: 31824349 PMCID: PMC6879649 DOI: 10.3389/fpsyt.2019.00842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/23/2019] [Indexed: 12/11/2022] Open
Abstract
Treatment guidelines for patients with schizophrenia recommend evaluating their risk of physical comorbidities, especially since these patients are known to have decreased life expectancy due to comorbidities. Therefore, to the authors' knowledge, this is the first national survey conducted to investigate how Italian psychiatrists deal with the risk of physical comorbidities and sexual dysfunction in patients with schizophrenia. A sample of 750 psychiatrists completed an ad hoc online survey investigating their decision making about performing blood tests, clinical and instrumental examinations, and scheduling follow-up appointments in relation to the different phases of the illness and possible pharmacological side effects. Compared to patients in therapeutic continuation, those diagnosed for the first time and those who received a therapeutic change were visited more frequently (every 15 to 17 days vs. every 40 days, respectively), and were more regularly prescribed blood tests and instrumental examinations (every 4.2 to 4.4 months vs. every 9 months, respectively). There was a high interest in the surveillance of cardiometabolic risk. In 54% of patients, prolactin testing was not requested before starting an antipsychotic. In terms of specialist referrals, only 5% of surveyed psychiatrists "never" sought for additional counseling. There was little attention given to sexual functioning assessment based on the survey results about patients' daily life and with regard to deciding to prescribe additional examinations. In fact, only up to 3% of psychiatrists reported assessing sexual functioning using specific psychometric tests. In summary, Italian psychiatrists describes themselves as careful healthcare providers for the physical illnesses of patients with schizophrenia but with several shortcomings. For instance, clinical attention toward patients' sexual and reproductive healthcare needs remains a challenge. Psychiatrists should take the lead for the integrated education, assessment, and care of medical needs of their patients with mental illness. Based on the results of this survey, the authors also believe that a future challenge for the management of patients with mental illness will be the classification of patients based on their risk of comorbidities, to help ensure optimal healthcare provision for those at greater risk of other illnesses.
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Affiliation(s)
- Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics, and Infant-Maternal Science, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Aderville Cabassi
- Department of Clinical and Experimental Medicine, Centro Studio dell'Ipertensione Arteriosa e delle Malattie Cardiorenali, Clinica e Terapia Medica, University of Parma, Parma, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Paolo Girardi
- Department NESMOS, Sapienza University of Rome, Rome, Italy
| | | | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscienze, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Department of Mental Health, University of L'Aquila, L'Aquila, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Siracusano
- Department of Medicine Systems, University of Rome Tor Vergata, Rome, Italy
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28
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Simoons M, Seldenrijk A, Mulder H, Birkenhäger T, Groothedde-Kuyvenhoven M, Kok R, Kramers C, Verbeeck W, Westra M, van Roon E, Bakker R, Ruhé H. Limited Evidence for Risk Factors for Proarrhythmia and Sudden Cardiac Death in Patients Using Antidepressants: Dutch Consensus on ECG Monitoring. Drug Saf 2018; 41:655-664. [PMID: 29484613 PMCID: PMC5990562 DOI: 10.1007/s40264-018-0649-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Currently, there is a lack of international and national guidelines or consensus documents with specific recommendations for electrocardiogram (ECG) screening and monitoring during antidepressant treatment. To make a proper estimation of the risk of cardiac arrhythmias and sudden (cardiac) death during antidepressant use, both the drug and patient-specific factors should be taken into account; however, solid evidence on how this should be done in clinical practice is lacking. Available recommendations on the management of QT(c) prolongation (with antidepressant treatment) emphasize that special attention should be given to high-risk patients; however, clinicians are in need of more concrete suggestions about how to select patients for ECG screening and monitoring. Based on a review of the literature, a Dutch multidisciplinary expert panel aimed to formulate specific guidelines to identify patients at risk for cardiac arrhythmias and sudden death by developing a consensus statement regarding ECG screening before, and monitoring during, antidepressant use. We first reviewed the literature to identify the relative risks of various risk factors on cardiac arrhythmia and sudden (cardiac) death during antidepressant use. These relative contributions of risk factors could not be determined since no systematic reviews or meta-analyses quantitatively addressed this topic. Because evidence was insufficient, additional expert opinion was used to formulate recommendations. This resulted in readily applicable recommendations for clinical practice for selection of high-risk patients for ECG screening and monitoring. ECG screening and monitoring is recommended before and following the start of QTc-prolonging antidepressants in the presence of vulnerability to QTc prolongation or two or more risk factors (age > 65 years, female sex, concomitant use of a QTc-prolonging drug or concomitant use of a drug that influences the metabolism of a QTc-prolonging drug, cardiac disease, excessive dosing and specific electrolyte disturbances).
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Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Unit of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Adrie Seldenrijk
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of Research and Innovation, GGZ InGeest, Amsterdam, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Psychiatric Hospital GGZ Drenthe, Assen, The Netherlands
| | - Tom Birkenhäger
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | | | - Rob Kok
- Department of Old Age Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Cornelis Kramers
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Wim Verbeeck
- Vincent van Gogh Institute for Psychiatry, ADHD and Autism Circuit, Venray, The Netherlands.,Department of Pharmacology and Toxicology, Radboudumc, Nijmegen, The Netherlands
| | - Mirjam Westra
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Eric van Roon
- Unit of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Roberto Bakker
- Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands.,Department of Psychiatry and Psychology, South Limburg Mental Health and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Henricus Ruhé
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. .,Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK. .,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.
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29
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Leckman-Westin E, Finnerty M, Scholle SH, Pritam R, Layman D, Kealey E, Byron S, Morden E, Bilder S, Neese-Todd S, Horwitz S, Hoagwood K, Crystal S. Differences in Medicaid Antipsychotic Medication Measures Among Children with SSI, Foster Care, and Income-Based Aid. J Manag Care Spec Pharm 2018; 24:238-246. [PMID: 29485947 PMCID: PMC10397713 DOI: 10.18553/jmcp.2018.24.3.238] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Concerns about antipsychotic prescribing for children, particularly those enrolled in Medicaid and with Supplemental Security Income (SSI), continue despite recent calls for selective use within established guidelines. OBJECTIVES To (a) examine the application of 6 quality measures for antipsychotic medication prescribing in children and adolescents receiving Medicaid and (b) understand distinctive patterns across eligibility categories in order to inform ongoing quality management efforts to support judicious antipsychotic use. METHODS Using data for 10 states from the 2008 Medicaid Analytic Extract (MAX), a cross-sectional assessment of 144,200 Medicaid beneficiaries aged < 21 years who received antipsychotics was conducted to calculate the prevalence of 6 quality measures for antipsychotic medication management, which were developed in 2012-2014 by the National Collaborative for Innovation in Quality Measurement. These measures addressed antipsychotic polypharmacy, higher-than-recommended doses of antipsychotics, use of psychosocial services before antipsychotic initiation, follow-up after initiation, baseline metabolic screening, and ongoing metabolic monitoring. RESULTS Compared with children eligble for income-based Medicaid, children receiving SSI and in foster care were twice as likely to receive higher-than-recommended doses of antipsychotics (adjusted odds ratio [AOR] = 2.4, 95% CI = 2.3-2.6; AOR = 2.5, 95% CI = 2.4-2.6, respectively) and multiple concurrent antipsychotic medications (AOR = 2.2, 95% CI = 2.0-2.4; AOR = 2.2, 95% CI = 2.0-2.4, respectively). However, children receiving SSI and in foster care were more likely to have appropriate management, including psychosocial visits before initiating antipsychotic treatment and ongoing metabolic monitoring. While children in foster care were more likely to experience baseline metabolic screening, SSI children were no more likely than children eligible for income-based aid to receive baseline screening. CONCLUSIONS While indicators of overuse were more common in SSI and foster care groups, access to follow-up, metabolic monitoring, and psychosocial services was somewhat better for these children. However, substantial quality shortfalls existed for all groups, particularly metabolic screening and monitoring. Renewed efforts are needed to improve antipsychotic medication management for all children. DISCLOSURES This project was supported by grant number U18HS020503 from the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS). Additional support for Rutgers-based participants was provided from AHRQ grants R18 HS019937 and U19HS021112, as well as the New York State Office of Mental Health. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ, CMS, or the New York State Office of Mental Health. Finnerty has been the principle investigator on research grants/contracts from Bristol Myers Squibb and Sunovion, but her time on these projects is fully supported by the New York State Office of Mental Health. Scholle, Byron, and Morden work for the National Committee for Quality Assurance, a not-for-profit organization that develops and maintains quality measures. Neese-Todd was at Rutgers University at the time of this study and is now employed by the National Committee for Quality Assurance. The other authors have no financial relationships relevant to this article to disclose. Study concept and design were contributed by Finnerty, Neese-Todd, and Crystal, assisted by Scholle, Leckman-Westin, Horowitz, and Hoagwood. Scholle, Byron, Morden, and Hoagwood collected the data, and data interpretation was performed by Pritam, Bilder, Leckman-Westin, and Finnerty, with assistance from Scholle, Byron, Crystal, Kealey, and Neese-Todd. The manuscript was written by Leckman-Westin, Kealey, and Horowitz and revised by Layman, Crystal, Leckman-Westin, Finnerty, Scholle, Neese-Todd, and Horowitz, along with the other authors.
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Affiliation(s)
- Emily Leckman-Westin
- 1 New York State Office of Mental Health, Albany, New York, and State University of New York at Albany, School of Public Health, Rensselaer, New York
| | - Molly Finnerty
- 2 New York State Office of Mental Health, and New York University Langone Health, New York, New York
| | | | - Riti Pritam
- 4 New York State Office of Mental Health, Albany, New York
| | - Deborah Layman
- 4 New York State Office of Mental Health, Albany, New York
| | - Edith Kealey
- 4 New York State Office of Mental Health, Albany, New York
| | - Sepheen Byron
- 3 National Committee for Quality Assurance, Washington, DC
| | - Emily Morden
- 3 National Committee for Quality Assurance, Washington, DC
| | | | | | - Sarah Horwitz
- 6 New York University Langone Health, New York, New York
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30
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Simoons M, Mulder H, Doornbos B, Schoevers RA, van Roon EN, Ruhé HG. Monitoring of somatic parameters at outpatient departments for mood and anxiety disorders. PLoS One 2018; 13:e0200520. [PMID: 30130372 PMCID: PMC6103503 DOI: 10.1371/journal.pone.0200520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/28/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Somatic complications account for the majority of the 13-30 years shortened life expectancy in psychiatric patients compared to the general population. The study aim was to assess to which extent patients visiting outpatient departments for mood and anxiety disorders were monitored for relevant somatic comorbidities and (adverse) effects of psychotropic drugs-more specifically a) metabolic parameters, b) lithium safety and c) ECGs-during their treatment. METHODS We performed a retrospective clinical records review and cross-sectional analysis to assess the extent of somatic monitoring at four outpatient departments for mood and anxiety disorders in The Netherlands. We consecutively recruited adult patients visiting a participating outpatient department between March and November 2014. The primary outcome was percentage of patients without monitoring measurements. Secondary outcomes were number of measurements per parameter per patient per year and time from start of treatment to first measurement. RESULTS We included 324 outpatients, of whom 60.2% were female. Most patients were treated for depressive disorders (39.8%), anxiety disorders (16.7%) or bipolar or related disorders (11.7%) and 198 patients (61.1%) used at least one psychotropic drug. For 186 patients (57.4%), no monitoring records were recorded (median treatment period 7.3 months, range 0-55.6). The median number of measurements per parameter per year since the start of outpatient treatment for patients with monitoring measurements was 0.31 (range 0.0-12.9). The median time to first monitoring measurement per parameter for patients with monitoring measurements was 3.8 months (range 0.0-50.7). DISCUSSION Somatic monitoring in outpatients with mood and anxiety disorders is not routine clinical practice. Monitoring practices need to be improved to prevent psychiatric outpatients from undetected somatic complications.
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Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Pharmacotherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands
- Mental Health Services Drenthe, Assen, The Netherlands
| | | | - Robert A. Schoevers
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Eric N. van Roon
- Department of Pharmacotherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Henricus G. Ruhé
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
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Hirsch L, Patten SB, Bresee L, Jette N, Pringsheim T. Second-generation antipsychotics and metabolic side-effects: Canadian population-based study. BJPsych Open 2018; 4:256-261. [PMID: 29998821 PMCID: PMC6060488 DOI: 10.1192/bjo.2018.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Use of second-generation antipsychotics (SGA) has increased in recent years; however, their use and effect on metabolic outcomes has been poorly characterised in population-level studies.AimsThis study aimed to determine the associations between SGA use and metabolic indicators in a general population. METHOD We used data from the Canadian Health Measures Survey, a cross-sectional survey of Canadian households. Participants were Canadians aged 3-79 years, living in one of the ten provinces. Several metabolic indicators were examined, including weight, body mass index, waist circumference, hypertension, diabetes and two definitions of metabolic syndrome. RESULTS The proportion of Canadians taking an SGA tripled over the study period. SGA use was significantly associated with hypertension (odds ratio 1.94, 95% CI 1.07-3.55) and abdominal obesity in adults, as defined by the National Cholesterol Education Program-Adult Treatment Panel III (odds ratio 2.62, 95% CI 1.45-4.71). CONCLUSIONS Evidence of metabolic dysfunction with SGAs is seen in the Canadian population, along with a rapid increase in prevalence of use since 2007.Declaration of interestNone.
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Affiliation(s)
- Lauren Hirsch
- Medical Student, Department of Community Health Sciences,Hotchkiss Brain Institute and O'Brien Institute of Public Health, University of Calgary,Canada
| | - Scott B Patten
- Professor, Department of Community Health Sciences,Hotchkiss Brain Institute,Department of Clinical Neurosciences, andO'Brien Institute of Public Health, University of Calgary,Canada
| | - Lauren Bresee
- Adjunct Assistant Professor, Department of Community Health SciencesandO'Brien Institute of Public Health, University of Calgary,Canada
| | - Nathalie Jette
- Professor, Department of Community Health Sciences,Hotchkiss Brain Institute,Department of Clinical Neurosciences, andO'Brien Institute of Public Health, University of Calgary,Canada
| | - Tamara Pringsheim
- Associate Professor, Department of Community Health Sciences,Hotchkiss Brain InstituteandDepartment of Clinical Neurosciences,University of Calgary,Canada
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Mangurian C, Modlin C, Williams L, Essock S, Riano NS, Shumway M, Newcomer JW, Dilley JW, Schillinger D. A Doctor is in the House: Stakeholder Focus Groups About Expanded Scope of Practice of Community Psychiatrists. Community Ment Health J 2018; 54:507-513. [PMID: 29185153 PMCID: PMC6218641 DOI: 10.1007/s10597-017-0198-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 11/04/2017] [Indexed: 12/24/2022]
Abstract
We sought to understand stakeholder perspectives on barriers to metabolic screening for people with severe mental illness. We additionally assessed the feasibility of expanding psychiatrists' scope of practice to include treatment of cardiometabolic abnormalities. We conducted four focus groups among patients with severe mental illness, community psychiatrists, primary care providers, and public health administrators. Focus group transcripts were thematically analyzed. Three domains emerged: challenges with patient navigation of the complex health care system, problem list prioritization difficulties, and concern that treatment of cardiometabolic abnormalities were beyond the scope of practice of psychiatrists. Stakeholders agreed that navigating the health care system was challenging for this population and led to undertreatment of cardiometabolic risk factors. Expansion of psychiatrists' scope of practice within community mental health appears acceptable to patients and may be a mechanism to improve cardiometabolic care among people with severe mental illness.
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Affiliation(s)
- Christina Mangurian
- The University of California, San Francisco, 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA.
| | - Chelsea Modlin
- The University of California, San Francisco, 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA
| | - Lindsey Williams
- The University of California, San Francisco, 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA
| | - Susan Essock
- New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 100, New York, NY, USA
| | - Nicholas S Riano
- The University of California, San Francisco, 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA
| | - Martha Shumway
- The University of California, San Francisco, 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA
| | - John W Newcomer
- Florida Atlantic University, 777 Glades Road, BC-71 Rm 241, Boca Raton, FL, USA
| | - James W Dilley
- The University of California, San Francisco, 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA
| | - Dean Schillinger
- New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 100, New York, NY, USA
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Goedecke T, Morales DR, Pacurariu A, Kurz X. Measuring the impact of medicines regulatory interventions - Systematic review and methodological considerations. Br J Clin Pharmacol 2018; 84:419-433. [PMID: 29105853 PMCID: PMC5809349 DOI: 10.1111/bcp.13469] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022] Open
Abstract
AIMS Evaluating the public health impact of regulatory interventions is important but there is currently no common methodological approach to guide this evaluation. This systematic review provides a descriptive overview of the analytical methods for impact research. METHODS We searched MEDLINE and EMBASE for articles with an empirical analysis evaluating the impact of European Union or non-European Union regulatory actions to safeguard public health published until March 2017. References from systematic reviews and articles from other known sources were added. Regulatory interventions, data sources, outcomes of interest, methodology and key findings were extracted. RESULTS From 1246 screened articles, 229 were eligible for full-text review and 153 articles in English language were included in the descriptive analysis. Over a third of articles studied analgesics and antidepressants. Interventions most frequently evaluated are regulatory safety communications (28.8%), black box warnings (23.5%) and direct healthcare professional communications (10.5%); 55% of studies measured changes in drug utilization patterns, 27% evaluated health outcomes, and 18% targeted knowledge, behaviour or changes in clinical practice. Unintended consequences like switching therapies or spill-over effects were rarely evaluated. Two-thirds used before-after time series and 15.7% before-after cross-sectional study designs. Various analytical approaches were applied including interrupted time series regression (31.4%), simple descriptive analysis (28.8%) and descriptive analysis with significance tests (23.5%). CONCLUSION Whilst impact evaluation of pharmacovigilance and product-specific regulatory interventions is increasing, the marked heterogeneity in study conduct and reporting highlights the need for scientific guidance to ensure robust methodologies are applied and systematic dissemination of results occurs.
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Affiliation(s)
- Thomas Goedecke
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
| | - Daniel R. Morales
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
- Division of Population Health SciencesUniversity of DundeeDundeeDD2 4BFUK
| | - Alexandra Pacurariu
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
- Dutch Medicines Evaluation Board3531AHUtrechtThe Netherlands
| | - Xavier Kurz
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
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Yarborough BJH, Perrin NA, Stumbo SP, Muench J, Green CA. Preventive Service Use Among People With and Without Serious Mental Illnesses. Am J Prev Med 2018; 54:1-9. [PMID: 29056371 PMCID: PMC5736432 DOI: 10.1016/j.amepre.2017.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION People with serious mental illnesses experience excess morbidity and premature mortality resulting from preventable conditions. The goal was to examine disparities in preventive care that might account for poor health outcomes. METHODS In this retrospective cohort study, adults (N=803,276) served by Kaiser Permanente Northwest and federally qualified health centers/safety-net community health clinics were categorized into five groups: schizophrenia spectrum disorders, bipolar disorders/affective psychoses, anxiety disorders, nonpsychotic unipolar depression, and reference groups with no evidence of these specific mental illnesses. The primary outcome was overall preventive care-gap rate, the proportion of incomplete preventive services for which each patient was eligible in 2012-2013. Secondary analyses examined Kaiser Permanente Northwest data from 2002 to 2013. Data were analyzed in 2015. RESULTS Controlling for patient characteristics and health services use, Kaiser Permanente Northwest mean care-gap rates were significantly lower for bipolar disorders/affective psychoses (mean=18.6, p<0.001) and depression groups (mean=18.6, p<0.001) compared with the reference group. Schizophrenia (mean=19.4, p=0.236) and anxiety groups (mean=19.9, p=0.060) did not differ from the reference group (mean=20.3). In community health clinics, schizophrenia (mean=34.1, p<0.001), bipolar/affective psychosis (mean=35.7, p<0.001), anxiety (mean=38.5, p<0.001), and depression groups (mean=36.3, p<0.001) had significantly lower care-gap rates than those in the reference group (mean=40.0). Secondary analyses of diabetes and dyslipidemia screening trends in Kaiser Permanente Northwest showed diagnostic groups consistently had fewer care gaps than patients in the reference group. CONCLUSIONS In vastly different settings, individuals with serious mental illnesses received preventive services at equal or better rates than the general population.
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Affiliation(s)
| | - Nancy A Perrin
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Scott P Stumbo
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - John Muench
- Oregon Health & Science University, Department of Family Medicine, Portland, Oregon
| | - Carla A Green
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
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Mangurian C, Schillinger D, Newcomer JW, Vittinghoff E, Essock S, Zhu Z, Dyer W, Schmittdiel J. Diabetes Screening among Antipsychotic-Treated Adults with Severe Mental Illness in an Integrated Delivery System: A Retrospective Cohort Study. J Gen Intern Med 2018; 33:79-86. [PMID: 29090381 PMCID: PMC5756176 DOI: 10.1007/s11606-017-4205-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/22/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe mental illness (SMI) is associated with increased risk for type 2 diabetes, partly due to adverse metabolic effects of antipsychotic medications. In public health care settings, annual screening rates are 30%. We measured adherence to national diabetes screening guidelines for patients taking antipsychotic medications. OBJECTIVE To estimate diabetes screening prevalence among patients with SMI within an integrated health care system, and to assess characteristics associated with lack of screening. DESIGN Retrospective cohort study. PARTICIPANTS Antipsychotic-treated adults with SMI. We excluded participants with known diabetes. MAIN MEASURES Primary outcome was screening via fasting glucose test or hemoglobin A1c during a 1-year period. KEY RESULTS In 2014, 16,754 patients with SMI diagnoses were receiving antipsychotics. Seventy-four percent of these patients' providers ordered diabetes screening tests that year, but only 55% (9247/16,754) received screening. When the observation time frame was extended to 2 years, 73% (12,250/16,754) were screened. Adjusting for sex and race/ethnicity, young adults (aged 18-29 years) were less likely to receive screening than older age groups [adjusted RR (aRR) 1.23-1.57, p < 0.0001]. Compared to whites, screening was more common for Asians (aRR 1.141, 95% CI 1.089-1.195, p < 0.0001), less common for blacks (aRR 0.946, 95% CI 0.898-0.997, p < 0.0375), and no different for Hispanics (aRR 1.030, 95% CI 0.988-1.074, p = 0.165). Smokers were less likely to be screened than non-smokers (aRR 0.93, 95% CI 0.89-0.97, p < 0.0008). Utilization of either mental health or primary care services increased the likelihood of screening. CONCLUSIONS While almost three-fourths of adults with SMI taking antipsychotic medications received a lab order for diabetes screening, only 55% received screening within a 12-month period. Young adults and smokers were less likely to be screened, despite their disproportionate metabolic risk. Future studies should assess the barriers and facilitators with regard to diabetes screening in this vulnerable population at the patient, provider, and system levels.
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry, University of California San Francisco (UCSF) Weill Institute of Neurosciences, San Francisco, CA, USA. .,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - Dean Schillinger
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - John W Newcomer
- Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA
| | - Eric Vittinghoff
- UCSF Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Susan Essock
- Columbia University Department of Psychiatry and the New York State Psychiatric Institute, New York, NY, USA
| | - Zheng Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Wendy Dyer
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Julie Schmittdiel
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
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Mulcahy AW, Normand SL, Newcomer JW, Colaiaco B, Donohue JM, Lave JR, Keeler E, Sorbero MJ, Horvitz-Lennon M. Simulated Effects of Policies to Reduce Diabetes Risk Among Adults With Schizophrenia Receiving Antipsychotics. Psychiatr Serv 2017; 68:1280-1287. [PMID: 28859580 PMCID: PMC5831671 DOI: 10.1176/appi.ps.201500485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Second-generation antipsychotics increase the risk of diabetes and other metabolic conditions among individuals with schizophrenia. Although metabolic testing is recommended to reduce this risk, low testing rates have prompted concerns about negative health consequences and downstream medical costs. This study simulated the effect of increasing metabolic testing rates on ten-year prevalence rates of prediabetes and diabetes (diabetes conditions) and their associated health care costs. METHODS A microsimulation model (N=21,491 beneficiaries) with a ten-year time horizon was used to quantify the impacts of policies that increased annual testing rates in a Medicaid population with schizophrenia. Data sources included California Medicaid data, National Health and Nutrition Examination Survey data, and the literature. In the model, metabolic testing increased diagnosis of diabetes conditions and diagnosis prompted prescribers to switch patients to lower-risk antipsychotics. Key inputs included observed diagnoses, prescribing rates, annual testing rates, imputed rates of undiagnosed diabetes conditions, and literature-based estimates of policy effectiveness. RESULTS Compared with 2009 annual testing rates, ten-year outcomes for policies that achieved universal testing reduced exposure to higher-risk antipsychotics by 14%, time to diabetes diagnosis by 57%, and diabetes prevalence by .6%. These policies were associated with higher spending because of testing and earlier treatment. CONCLUSIONS The model showed that policies promoting metabolic testing provided an effective approach to improve the safety of second-generation antipsychotic prescribing in a Medicaid population with schizophrenia; however, the policies led to additional costs at ten years. Simulation studies are a useful source of information on the potential impacts of these policies.
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Affiliation(s)
- Andrew W Mulcahy
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Sharon-Lise Normand
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - John W Newcomer
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Benjamin Colaiaco
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Julie M Donohue
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Judith R Lave
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Emmett Keeler
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Mark J Sorbero
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
| | - Marcela Horvitz-Lennon
- Dr. Mulcahy is with RAND Corporation, Arlington, Virginia. Dr. Normand is with the Department of Health Care Policy, Harvard Medical School, and with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston. Dr. Newcomer is with the Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Mr. Colaiaco is with the Allegheny Health Network, Pittsburgh. Dr. Keeler is with RAND Corporation, Santa Monica, California, where Mr. Colaiaco was affiliated at the time of this study. Dr. Donohue and Dr. Lave are with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh. Mr. Sorbero is with RAND Corporation, Pittsburgh. Dr. Horvitz-Lennon is with RAND Corporation, Boston
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Chee GL, Wynaden D, Heslop K. Improving metabolic monitoring rate for young people aged 35 and younger taking antipsychotic medications to treat a psychosis: A literature review. Arch Psychiatr Nurs 2017; 31:624-633. [PMID: 29179831 DOI: 10.1016/j.apnu.2017.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 08/14/2017] [Accepted: 09/03/2017] [Indexed: 01/08/2023]
Abstract
Young people aged 35 and younger who are taking antipsychotic medications to treat a psychosis are a high risk for developing metabolic syndrome due to the adverse effects of the medications. This paper reports the finding of a review of literature to identify interventions to improve metabolic monitoring rates in this group. A review of 478 studies identified 15 articles which met the inclusion criteria. Five articles reported single-intervention studies and the remaining integrated two or more interventions to improve uptake level of metabolic monitoring. As metabolic syndrome can be detected early through metabolic monitoring in young people taking antipsychotics, early intervention is important to improve their physical health trajectory.
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Affiliation(s)
- Gin-Liang Chee
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Black DR, Held ML. Cardiovascular risk screening for individuals with serious mental illness. SOCIAL WORK IN HEALTH CARE 2017; 56:809-821. [PMID: 28771089 DOI: 10.1080/00981389.2017.1354955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cardiovascular disease (CVD) is a significant health risk for individuals with serious mental illness (SMI). Screening for CVD risk factors is a key strategy to reduce this health disparity. This study examined medical, lifestyle, and access predictors for comprehensive screening. Data on 1036 adults were analyzed from the 2015 National Health Interview Survey. Multivariate multinomial logistic regression was used to examine factors associated with individuals with SMI receiving CVD risk screening in the past 12 months. The presence of a metabolic disorder (diabetes or high cholesterol), increased age, increased outpatient visits, and seeing a primary care provider, either alone or in conjunction with a specialty care provider, were significantly associated with receiving all screening measures. Increasing provider awareness of additional CVD risk factors is an essential step to improving early detection of health risks for individuals with SMI. Integrated health settings that combine traditional primary care and mental health services may reduce the health disparity for this population by increasing odds of early detection and ongoing monitoring for high-risk populations.
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Affiliation(s)
- Denise R Black
- a College of Social Work , University of Tennessee , Knoxville , TN , USA
| | - Mary L Held
- b College of Social Work , University of Tennessee , Nashville , TN , USA
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Strassnig M, Kotov R, Cornaccio D, Fochtmann L, Harvey PD, Bromet EJ. Twenty-year progression of body mass index in a county-wide cohort of people with schizophrenia and bipolar disorder identified at their first episode of psychosis. Bipolar Disord 2017; 19:336-343. [PMID: 28574189 PMCID: PMC5568920 DOI: 10.1111/bdi.12505] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/25/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There is an increased prevalence of obesity in schizophrenia and bipolar disorder, leading to a disproportionate risk of adverse health conditions. Prospective, long-term weight gain data, however, are scarce. METHODS We analyzed data from the Suffolk County Mental Health Project cohort of consecutive first admissions with psychosis recruited from September 1989 to December 1995 and subsequently followed for 20 years, focusing on people with schizophrenia (n=146) and bipolar disorder (n=87). The time course of weight gain was examined using a 2 (group)×5 (time) mixed-model repeated measures ANOVA, and body mass index (BMI) scores at the first (6 months) and second (2 years) assessments were compared to examine whether early overweight predicted later obesity. RESULTS There was a statistically significant effect of time (F(1,210)=68.06, P<.001) and diagnosis (F(1,210)=29.18, P<.001) on BMI, but not the interaction of time×diagnosis (F(1,210)=0.88, P=.48). Most participants had normal BMIs at the first two assessments. Early overweight was a predictor of eventual obesity for both groups. At the 20-year follow-ups, approximately 50% of the bipolar and 62% of the schizophrenia sample were obese, with a greater prevalence of obesity in schizophrenia at each assessment (all P<.02), except for years 4 (P=.12) and 20 (P=.27). CONCLUSIONS Nearly two-thirds of the participants with schizophrenia and over half of those with bipolar disorder were obese 20 years after first hospitalization for psychosis, considerably higher than the rate for adults in New York State (27%). Early intervention may be required to prevent long-term consequences of obesity-related morbidity and mortality.
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Affiliation(s)
- M Strassnig
- Department of Integrated Medical Science, Charles Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431
| | - R Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Danielle Cornaccio
- School of Integrated Science and Humanity, Florida International University
| | - L Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - PD Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine
| | - EJ Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
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Tai MH, Lee B, Onukwugha E, Zito JM, Reeves GM, dosReis S. Impact of Coordinated Behavioral Health Management on Quality Measures of Antipsychotic Use. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 45:174-185. [DOI: 10.1007/s10488-017-0807-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Strassnig M, Clarke J, Mann S, Remington G, Ganguli R. Body composition, pre-diabetes and cardiovascular disease risk in early schizophrenia. Early Interv Psychiatry 2017; 11:229-236. [PMID: 25752319 DOI: 10.1111/eip.12225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/19/2014] [Indexed: 12/13/2022]
Abstract
AIM This preliminary study examines the relationship between body composition, insulin resistance and NCEP-III-defined cardiovascular disease risk factors in persons early in the course of schizophrenia exposed to commonly prescribed atypical antipsychotic medications. METHODS Subjects underwent modified oral glucose tolerance tests (OGTTs) and DEXA (dual X-ray absorptiometry) scans corrected for relevant sociodemographic data, including activity levels. We used linear multiple regression models to evaluate relationships between body composition and metabolic variables. RESULTS Thirty-six individuals diagnosed with schizophrenia, receiving atypical antipsychotic monotherapy, and within 5 years of illness onset, participated. Average age was 25.1 ± 3.6 years (range, 19-34) and duration of illness was 2.5 years (30 ± 18 months). Mean body mass index (BMI) was 28.3 ± 4.9, with a mean total body fat mass of 28.6 ± 8.4%, suggesting an increase in fat relative to BMI. Ten participants (28%) had pre-diabetes (fasting glucose 100-126 mg dL-1 or 2-h OGTT 140-200 mg dL-1 ), but no participant had diabetes. Insulin resistance (HOMA-IR) was predicted by total body mass (BMI) more so than by body fat mass, with an incremental contribution derived from antipsychotics. Insulin secretion in response to glucose challenge was predicted by BMI, body fat mass and antipsychotic medication. CONCLUSIONS Fat mass relative to BMI was increased in early schizophrenia patients receiving atypical antipsychotics. Body composition accounted for most of the variance in risk for abnormalities in glucose metabolism. Incremental contributions were derived from atypical antipsychotics, in line with their known adipogenicity. If direct fat mass measures are unavailable, frequent BMI measures may be practical proxy markers for metabolic risk.
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Affiliation(s)
- Martin Strassnig
- Department of Psychiatry, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jennifer Clarke
- Department of Epidemiology and Biostatistics, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Steve Mann
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Gary Remington
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Rohan Ganguli
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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Reeves R, Tamburello A, DeBilio L. Metabolic Syndrome Prevalence and Reduction in Inmates Prescribed Antipsychotic Medications. JOURNAL OF CORRECTIONAL HEALTH CARE 2017; 23:203-213. [PMID: 28366084 DOI: 10.1177/1078345817700802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The principal aim of this study was to establish whether a metabolic monitoring program implemented for second-generation antipsychotic medications (SGAs) was associated with any reduction in the prevalence of metabolic syndrome in adult inmates treated with antipsychotic medications in the New Jersey Department of Corrections. The average prevalence of metabolic syndrome in those prescribed SGAs decreased from 17.9% during the years before metabolic monitoring to 14.3% during the years of monitoring. The number of patients prescribed antipsychotic medication decreased a net 35% over 9 years of the study. We conclude that metabolic monitoring was one of the several administrative interventions over the study period that reduced the unnecessary exposure of inmates to the risks of antipsychotic medications.
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Affiliation(s)
- Rusty Reeves
- 1 Rutgers-University Correctional Health Care, Trenton, NJ, USA.,2 Rutgers University-Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Anthony Tamburello
- 1 Rutgers-University Correctional Health Care, Trenton, NJ, USA.,2 Rutgers University-Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Lisa DeBilio
- 1 Rutgers-University Correctional Health Care, Trenton, NJ, USA
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43
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Ndukwe HC, Nishtala PS. Glucose monitoring in new users of second-generation antipsychotics in older people. Arch Gerontol Geriatr 2017; 70:136-140. [PMID: 28131975 DOI: 10.1016/j.archger.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Treatment guidelines published world-wide have highlighted concerns of increased metabolic risks associated with second-generation antipsychotics (SGAs). The aim of the study was to evaluate blood glucose monitoring rates for SGA new users in older people aged 65 years and above during the study period 2006-2012, and investigate the pre-post 2007 Best Practice Advocacy Centre's (bpacnz) glucose monitoring recommendation in New Zealand. METHODS The study was a population-based retrospective cohort of SGA new users (365days without pre-exposure to antipsychotics). Pharmaceutical collections data were extracted and used to identify older people dispensed SGAs and linked to the National Minimum Dataset and Laboratory Claims collection. WHO Methodology's Anatomical Therapeutic Chemical method's classification was used to characterise the SGAs dispensed. RESULTS Of the 25,603 new users dispensed SGAs, 63.5% received glycaemic control monitoring at least once during the study period. Of these, only 20.1% were monitored at baseline, 38.7% were monitored for glycaemic control within the first 90 days. Glycaemic control monitoring within the first 180days increased to more than half (57.5%) of the SGA new users. Proportion of individuals monitored were independent (χ2=6.1; P=0.4) of pre-post bpacnz recommendation. CONCLUSIONS Blood glucose monitoring was underutilized in new SGA users. No significant improvement in glycaemic control monitoring was observed after the 2007 bpacnz consensus statement release at baseline, 90days and at 180 days. Prescribers must be cautioned about the metabolic risks posed by SGAs and recommend glycaemic control monitoring.
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Affiliation(s)
- Henry C Ndukwe
- School of Pharmacy, P.O. Box 56, University of Otago, Dunedin, New Zealand.
| | - Prasad S Nishtala
- School of Pharmacy, P.O. Box 56, University of Otago, Dunedin, New Zealand.
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Nash K, Ghinassi F, Brar JS, Alam A, Bohan MC, Gopalan K, Carter A, Chengappa KNR. The Development and Implementation of an Electronic Health Record Tool for Monitoring Metabolic Syndrome Indices in Patients with Serious Mental Illness. ACTA ACUST UNITED AC 2017; 10:145-153. [PMID: 27732099 DOI: 10.3371/1935-1232.10.3.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES 1. A quality performance improvement (QI) project to implement an electronic screening and monitoring tool to record components of the metabolic syndrome (e-MSD) during clinic visits by persons with serious mental illness (SMI). 2. To encourage psychiatrists to use this tool in their documentation. METHODS Working with the information technology staff, five psychiatrists developed, tested, revised and embedded the e-MSD tool into the medication management document within the electronic health record. A continuing medical education program on metabolic syndrome was developed and released to psychiatrists and mental health clinicians. Psychiatrist offices at one clinic were equipped with weighing scales, sphygmomanometers, waist circumference tapes, and a QI project was initiated. RESULTS At one month, 9 to 12% of the anthropometric measures (height, weight, body mass index, waist circumference, and blood pressure) were recorded in 974 unique patient encounters, and one year later the numbers moved upward from 15 to 41%. Toward the end of Year 1, a Patient Care Associate was hired to measure the anthropometric measures and, one year later, the documented rates increased to 75-80%. Laboratory recordings (glucose and lipids) remained ≤8% throughout the first year, but moved upward to 25% in Year 2. DISCUSSION Notwithstanding significant administrative and technical support for this QI project, changing clinician practice to screen, monitor and document metabolic indices in persons with SMI in the ambulatory setting changed significantly after the hiring of a Patient Care Associate. Efforts to obtain laboratory measures in real time remain a challenge. Next steps include interventions to promote weight loss and smoking cessation in SMI patients, and effective communication with their primary care doctors.
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Pan YJ, Yeh LL, Chen YC, Chan HY. Three-year mortality in relation to early hospitalization and number of outpatient clinic visits in people with newly diagnosed bipolar disorder. Gen Hosp Psychiatry 2016; 43:32-37. [PMID: 27796255 DOI: 10.1016/j.genhosppsych.2016.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Whether the early treatment pattern in people with bipolar disorder (BD) could influence later mortality remains to be determined. We aimed to explore the potential effects of early hospitalization and number of outpatient clinic visits on the 3-year mortality in patients with newly diagnosed BD. METHOD Adult participants with newly diagnosed BD were identified in Taiwan's National Health Insurance Research Database in 2008. Survival analyses were performed with this national cohort to examine the associations between the first-year treatment pattern (hospitalization and number of outpatient clinic visits) and mortality over a follow-up period of 3 years (2008-2011). RESULTS A total of 15,254 participants were included. The mean age was 44.9 (S.D.=16.7) years and around 39.9% were male. The average follow-up time was 1055 days. Compared to BD patients with ≥7 times outpatient clinic visits within the first year, the risk of mortality was found elevated [hazard ratio=1.74; 95% confidence interval (CI), 1.40-2.15] for those who needed inpatient treatment. Number of outpatient clinic visits within the first year was found to be negatively associated with later mortality. Besides cancer (hazard ratio=2.14; 95% CI, 1.74-2.63), diabetes mellitus (hazard ratio=1.61; 95% CI, 1.38-1.89) and renal disease (hazard ratio=1.65; 95% CI, 1.36-2.00) were associated with the highest risk of mortality among the physical comorbidities. Substance use disorder stood out as the single comorbid mental illness associated with the highest mortality risk (hazard ratio=1.74; 95% CI, 1.37-2.21). CONCLUSIONS Early treatment pattern, including hospitalization and number of outpatient clinic visits, was associated with later mortality in BD patients. Special care should be given to enhance treatment adherence and to give psychoeducation to those with certain comorbid mental/physical illnesses to reduce health harming behavior and to improve health outcome.
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Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan; Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Ling Yeh
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Yu-Chun Chen
- Department of Medical Research and Education, National Yang-Ming University Hospital, Yilan, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
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Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review. J Gen Intern Med 2016; 31:1083-91. [PMID: 27149967 PMCID: PMC4978675 DOI: 10.1007/s11606-016-3712-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 01/20/2023]
Abstract
Close to 19 million US adults have severe mental illnesses (SMI), and they die, on average, 25 years earlier than the general population, most often from cardiovascular disease (CVD). Many of the antipsychotic medications used to treat SMI contribute to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension. Based on compelling evidence, the American Diabetes Association and the American Psychiatric Association developed guidelines for metabolic screening and monitoring during use of these medications.In this manuscript, we have reviewed the evidence on diabetes and other CVD risk screening, prevalence, and management among populations with SMI. We also review differences in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women, and children). We found that despite national guidelines for screening for diabetes and other cardiovascular risk factors, up to 70 % of people taking antipsychotics remain unscreened and untreated. Based on estimates that 20 % of the 19 million US adults with SMI have diabetes and 70 % of them are not screened; it is likely that over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates to over $8 billion in annual preventable costs to our healthcare system.Given the high burden of disease and significant evidence of suboptimal medical care received by people with SMI, we propose several clinical and policy recommendations to improve diabetes and other CVD risk screening and care for this highly vulnerable population. These recommendations include reducing antipsychotic medication dose or switching antipsychotic medications, enhancing smoking cessation efforts, sharing electronic health records between physical and mental health care systems, and promoting integration of care.
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47
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Edelsohn GA, Parthasarathy M, Terhorst L, Karpov IO, Schuster J. Measurement of Metabolic Monitoring in Youth and Adult Medicaid Recipients Prescribed Antipsychotics. J Manag Care Spec Pharm 2016; 21:769-77, 777a-777cc. [PMID: 26308224 PMCID: PMC10397640 DOI: 10.18553/jmcp.2015.21.9.769] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Individuals being treated with first- and second-generation antipsychotics (FGAs and SGAs) are at risk for a variety of adverse cardiometabolic effects. Although consensus guidelines that recommend metabolic monitoring for patients receiving SGAs have been in place since 2004, the rate of monitoring remains low, especially in the pediatric population. OBJECTIVES To (a) examine differences in rates of laboratory monitoring for glucose and lipids for adults and youth prescribed FGAs and SGAs; (b) look at factors associated with the likelihood of metabolic testing; and (c) describe cohort effects that may have had an impact on the rates of laboratory testing. METHODS This is a retrospective study examining the rates of glucose and lipid testing for 3 separate cohorts of Medicaid recipients who were prescribed antipsychotics during 3 measurement periods-2008, 2010, and 2012-using paid Medicaid pharmacy and laboratory claims data. The sample included adults aged 18 years and older and children aged 17 years and younger. For each measurement period, we identified the rate of metabolic monitoring and the demographic characteristics for each individual, including race, age, and gender. The proportion of laboratory monitoring was assessed using chi square tests for each of the outcomes. Logistic regression models for each time point were used to determine the characteristics of individuals who were more likely to receive monitoring. RESULTS The proportion of individuals receiving glucose and lipid tests increased for both age groups across all measurement periods. For individuals aged 18 years and over, glucose monitoring increased from 56.6%-72.6%. Testing for lipids remained constant, ranging from 38.3%-41.2% for each of the 3 measurement periods. During the first measurement period, in 2008, females were 41% and 15% more likely to receive glucose and lipid laboratory monitoring, respectively, compared with males. Females continued to be more likely to receive glucose monitoring during the measurement periods in 2010 and 2012, although there was no significant difference between females and males for lipid monitoring during these time periods. Individuals aged 17 years and younger were 59%-68% less likely to receive glucose monitoring than adults (aged ≥ 18 years) for all time points. Across all measurement periods, individuals aged ≤ 17 years were also 44%-58% less likely to receive lipid monitoring compared with adults (aged ≥ 18 years). While there was no significant difference between Caucasians and non-Caucasians in the first measurement period, Caucasians were about 30% less likely to receive glucose monitoring and about 50% less likely to receive lipid monitoring during the measurement periods covering 2010 and 2012. CONCLUSIONS Metabolic monitoring in adults improved substantially over the time periods studied; however, rates remained suboptimal, especially in the pediatric population. This finding suggests that interventions to increase metabolic monitoring in adults and children using FGAs and SGAs are necessary.
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Affiliation(s)
- Gail A Edelsohn
- Community Care Behavioral Health Organization, 1 E. Uwchlan Ave., Ste. 311, Exton, PA 19341.
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Baxter AJ, Harris MG, Khatib Y, Brugha TS, Bien H, Bhui K. Reducing excess mortality due to chronic disease in people with severe mental illness: meta-review of health interventions. Br J Psychiatry 2016; 208:322-9. [PMID: 26941263 DOI: 10.1192/bjp.bp.115.163170] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 09/21/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND People with severe mental illness (SMI) have high rates of chronic disease and premature death. AIMS To explore the strength of evidence for interventions to reduce risk of mortality in people with SMI. METHOD In a meta-review of 16 systematic reviews of controlled studies, mortality was the primary outcome (8 reviews). Physiological health measures (body mass index, weight, glucose levels, lipid profiles and blood pressure) were secondary outcomes (14 reviews). RESULTS Antipsychotic and antidepressant medications had some protective effect on mortality, subject to treatment adherence. Integrative community care programmes may reduce physical morbidity and excess deaths, but the effective ingredients are unknown. Interventions to improve unhealthy lifestyles and risky behaviours can improve risk factor profiles, but longer follow-up is needed. Preventive interventions and improved medical care for comorbid chronic disease may reduce excess mortality, but data are lacking. CONCLUSIONS Improved adherence to pharmacological and physical health management guidelines is indicated.
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Affiliation(s)
- Amanda J Baxter
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Meredith G Harris
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Yasmin Khatib
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Traolach S Brugha
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Heidrun Bien
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Kamaldeep Bhui
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
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Lee J, Dalack GW, Casher MI, Eappen SA, Bostwick JR. Persistence of metabolic monitoring for psychiatry inpatients treated with second-generation antipsychotics utilizing a computer-based intervention. J Clin Pharm Ther 2016; 41:209-13. [PMID: 26919449 DOI: 10.1111/jcpt.12368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Monitoring and intervention for metabolic abnormalities secondary to second-generation antipsychotics (SGAs) remain weak areas of performance in mental health care. This study evaluated the sustained impact of a computerized physician order entry (CPOE) pop-up alert designed to improve rates of laboratory metabolic monitoring of patients treated with SGAs in an inpatient psychiatry unit. Interventions carried out by the psychiatry team to manage metabolic abnormalities found on screening were also identified. METHODS A retrospective chart review of patients treated with scheduled SGAs at a large Midwestern academic medical centre's inpatient adult psychiatry unit was conducted nearly 4 years after the initial implementation of a pop-up alert. Rates of laboratory monitoring (blood glucose level, haemoglobin A1C [HbA1c], lipid panel) were compared to those following the initial implementation. Medical charts of patients with abnormal laboratory results were also reviewed to summarize interventions made by the psychiatry team to manage identified abnormalities. RESULTS AND DISCUSSION Patient demographics in the current study population (n = 129) were similar to those in the initial test cohort (n = 157). There was no significant decrease in monitoring of glucose levels and lipid panels (fasting or random). Nine patients with abnormally elevated laboratories were identified. Interventions by the psychiatry team included referrals to appropriate healthcare professionals and initiation of medication. WHAT IS NEW AND CONCLUSIONS The rate of metabolic monitoring for inpatients on SGA therapy did not significantly change over time with the continued use of the CPOE pop-up alert. Optimal monitoring utilizing a CPOE pop-up alert may allow the psychiatry team, including psychiatric pharmacists, to better manage metabolic conditions.
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Affiliation(s)
- J Lee
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - G W Dalack
- University of Michigan Department of Psychiatry, Ann Arbor, MI, USA.,University of Michigan Health System, Ann Arbor, MI, USA
| | - M I Casher
- University of Michigan Department of Psychiatry, Ann Arbor, MI, USA.,University of Michigan Health System, Ann Arbor, MI, USA
| | - S A Eappen
- University of Michigan Health System, Ann Arbor, MI, USA
| | - J R Bostwick
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA.,University of Michigan Health System, Ann Arbor, MI, USA
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Lui K, Randhawa G, Totten V, Smith AE, Raese J. Is Metabolic Syndrome On the Radar? Improving Real-Time Detection of Metabolic Syndrome and Physician Response by Computerized Scan of the Electronic Medical Record. Prim Care Companion CNS Disord 2016; 18:15m01849. [PMID: 27247842 DOI: 10.4088/pcc.15m01849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Metabolic syndrome is a common underdiagnosed condition among psychiatric patients exacerbated by second-generation antipsychotics, with the exception of aripiprazole and ziprasidone. This study evaluated the prescribing and treating behavior with regard to antipsychotics and metabolic syndrome of psychiatrists before and after implementation of a mandatory admission order set and electronic notification of results. METHOD Baseline data from 9,100 consecutive psychiatric admissions to a mental health hospital (July 2013-July 2014) were compared to postintervention data (July 2014-January 2015), which included 1,499 consecutive patient records. The intervention initiated standardized admission testing with electronic notification to psychiatrists when patients met metabolic syndrome criteria (according to Axis III of the DSM-IV). Charts were examined for inclusion of this diagnosis at discharge and for treatment changes. RESULTS At baseline, only 2.4% of patients (n = 214) were evaluated for metabolic syndrome. Of these, 34.5% (0.8% of the total sample) met metabolic syndrome criteria. Only 15 patients (0.16%) were comprehensively treated. No chart listed metabolic syndrome under Axis III of the DSM-IV. After the intervention, the diagnosis of patients meeting the criteria for metabolic syndrome increased from 0% to 29.3%. Less than 3% of patients were switched to drugs with a more benign metabolic profile. All patients who continued on second-generation antipsychotics had metabolic retesting. Thirty-eight experienced a significant and rapid increase in triglyceride levels after only 3 to 17 days. CONCLUSIONS Mandatory intake testing increases the number of patients evaluated for metabolic syndrome. Electronic alerts increase the inclusion of metabolic syndrome among discharge diagnoses but rarely affect prescribing practices.
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Affiliation(s)
| | | | | | - Adam E Smith
- Statistical and Research Consultant, Kaweah Delta Health Care District, Visalia, California
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