To improve safety of patients receiving antipsychotics, clinicians and researchers from the South Central Veterans Affairs Health Care Network (SCVAHCN) Mental Health Product Line, the South Central Mental Illness, Research, Education and Clinical Center (MIRECC) and the Mental Health QUERI collaborated to 1) develop side effect monitoring recommendations; 2) develop and implement a performance measure; and 3) educate providers about monitoring.
Representatives from all three groups worked together to develop evidence-based monitoring recommendations. After peer-review by psychopharmacology experts, the recommendations were printed in a pocket-sized booklet. The booklets and a slide set explaining the performance measures were distributed to the SCVAHCN Chiefs of Mental Health for further dissemination to clinic staff. The mental health product line used these recommendations as the basis for development of performance measures for monitoring weight and blood glucose/hemoglobin A1c. The SCVAHCN data warehouse was used to determine performance measure results. The performance measures applied to all patients receiving new antipsychotic prescriptions in a mental health clinic. To be fully successful, a facility must monitor weight of 85% of patients and blood glucose/hemoglobin A1c of 70% of patients within 180 days prior to or 30 days after initiation of an antipsychotic.
During FY03, 4066 patients at 10 facilities were included in the performance measure. At baseline, 85% (range: 73.5%-98.9%) of the patients had weight measured and 68.3% (range: 51.4%-82.9%) had a blood glucose or hemoglobin A1c. As of August 04, 3995 patients were available for evaluation. At baseline 88% had weight (range: 80%-100%) and 74% (range: 67.8%-88.6%) had blood glucose or hemoglobin A1c measured. Eight of 10 facilities and seven of 10 facilities met the fully successful criterion for monitoring weight and blood glucose/hemoglobin A1c respectively. Weight monitoring improved in 8/10 facilities and monitoring of blood glucose/hemoglobin A1c improved in 7/10 facilities.
This project represents a close collaboration between clinicians and researchers and is one of the first efforts to define and implement routine physical health monitoring for antipsychotic medications. Although the improvements in monitoring were relatively small, some facilities made substantial improvements. Future directions include developing a performance measure for serum lipids.