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Do Veterans Prescribed Antipsychotics Receive Recommended Monitoring for Metabolic Side Effects?

Viverito KM, Owen RR, Mittal D, Li C, Williams JS. Do Veterans Prescribed Antipsychotics Receive Recommended Monitoring for Metabolic Side Effects? Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 19; National Harbor, MD.




Abstract:

Objectives: Past studies have investigated monitoring of metabolic side effects of antipsychotics among Veterans, but this retrospective cohort analysis is unique due to strict definitions of monitoring and focus on VISN 18-22 outpatients regardless of diagnosis. Methods: Service utilization, diagnoses, prescriptions, and laboratory use data were extracted from the VHA Medical SAS Datasets. Vital sign data were extracted from the Region 1 Data Warehouse. Outpatients were included if they had: 1. A new antipsychotic ("index prescription") prescribed from 4/2008 - 5/2009 with at least 60 days supply in the subsequent 90 days. 2. A stable medication regimen in the six months prior to the index prescription (the new prescription likely represents a new treatment episode). Baseline monitoring (weight, glucose or hemoglobin A1c, and LDL recorded -30 to +30 days from index prescription) and follow-up monitoring (parameters recorded +60 to +120 days after index prescription) were defined using 2004 ADA/APA consensus recommendations. Multivariate logistic regression models examined the association of patient characteristics with the likelihood of receiving recommended monitoring for each parameter. Results: The final sample consisted of 12,009 Veterans. The most frequently monitored metabolic parameter was weight at baseline (66.6%) and follow-up (49.5%). 74.6% of patients received monitoring of at least one parameter at baseline. 55.2% received some monitoring at follow-up. The strongest predictors of monitoring were medical co-morbidities. Interestingly, monitoring rates between Veterans with non-psychotic disorders and schizophrenia did not significantly differ. However, Veterans with no mental health diagnosis had significantly lower monitoring rates. Off label prescriptions were common. The majority of patients did not have psychotic disorders and only one third had a diagnosis of schizophrenia, affective psychosis, or other psychosis combined. Implications: Efforts are needed to improve monitoring for metabolic side-effects of antipsychotics. Additionally, clinicians and patients should carefully consider the risks and benefits prior to selecting a medication and/or beginning antipsychotic medication for non-psychotic illnesses. Impacts: Quality improvement efforts are urgently needed. The development of efficient monitoring processes will lead to improved management of metabolic side-effects and improve the overall quality and safety of care for Veterans receiving antipsychotic treatment while minimizing burden on clinicians





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