Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-28T00:13:16.099Z Has data issue: false hasContentIssue false
  • English
  • Français

A health screening and promotion clinic to improve metabolic monitoring for patients prescribed antipsychotic medication

Published online by Cambridge University Press:  22 May 2013

D. Gallagher ,
M. Buckley ,
C. Kenny ,
C. Onwudiwe ,
C. Young ,
J. Rutledge ,
I. Grenham  and
M. Kilduff
D. Gallagher*
Affiliation:
Department of Psychiatry, St Vincent's Hospital, Fairview, Dublin, Ireland
M. Buckley
Affiliation:
Department of Psychiatry, St Vincent's Hospital, Fairview, Dublin, Ireland
C. Kenny
Affiliation:
Department of Psychiatry, St Vincent's Hospital, Fairview, Dublin, Ireland
C. Onwudiwe
Affiliation:
Department of Psychiatry, St Vincent's Hospital, Fairview, Dublin, Ireland
C. Young
Affiliation:
Millmount Mental Health Centre, Millmount Avenue, Dublin, Ireland
J. Rutledge
Affiliation:
Millmount Mental Health Centre, Millmount Avenue, Dublin, Ireland
I. Grenham
Affiliation:
Millmount Mental Health Centre, Millmount Avenue, Dublin, Ireland
M. Kilduff
Affiliation:
Department of Psychiatry, St Vincent's Hospital, Fairview, Dublin, Ireland
*
*Address for correspondence: Dr D. Gallagher, Department of Old Age Psychiatry, St Vincent's University Hospital, Dublin 4, Ireland. (Email [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

We sought to determine whether the introduction of a health screening and promotion clinic might serve as a useful addition to existing services for patients prescribed antipsychotic medication. In particular, we wished to assess whether such a clinic might improve adherence to best practice guidelines. We also wished to determine the level of patient interest in such a clinic and how readily this service might be provided within the constraints of existing clinical resources.

Methods

We conducted an audit of outpatient records before and following the introduction of a health screening and promotion clinic.

Results

Of the eligible patients, 73% attended the clinic. The proportion of patients who had fasting blood tests within the previous 12 months increased from 45% at baseline to 85% at follow-up (χ2 = 14.1, p < 0.001). The proportion of patients with appropriate physical observations completed increased from 5% at baseline to 80% at follow-up (χ2 = 46.0, p < 0.001).

Conclusions

We found that the introduction of a health screening and promotion clinic improved adherence to best practice guidelines. This service was well received and readily provided within the constraints of existing resources. Ultimately, the structure of services to screen and advise patients prescribed antipsychotic medication will be determined by local resource considerations and configuration of services.

Keywords

Antipsychotic medicationhealth screeningmetabolic monitoring
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 30 , Issue 2 , June 2013 , pp. 113 - 118
Copyright
Copyright © College of Psychiatrists of Ireland 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barnes, TR, Paton, C, Cavanagh, MR, Hancock, E, Taylor, DM (2007). A UK audit of screening for the metabolic side effects of antipsychotics in community patients. Schizophrenia Bulletin 33, 1397–1403.CrossRefGoogle ScholarPubMed
Brown, S, Birtwistle, J, Roe, L, Thompson, C (1999). The unhealthy lifestyle of people with schizophrenia. Psychological Medicine 29, 697–701.CrossRefGoogle ScholarPubMed
Brown, S, Kim, M, Mitchell, C, Inskip, H (2010). Twenty-five year mortality of a community cohort with schizophrenia. British Journal of Psychiatry 196, 116–121.CrossRefGoogle ScholarPubMed
Cardiovascular Risk Calculator (2011). University of Edinburgh (http://cvrisk.mvm.ed.ac.uk/). Accessed 2 February 2011.Google Scholar
Chang, CK, Hayes, RD, Perera, G, Broadbent, MT, Fernandes, AC, Lee, WEetal. (2011). Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS One 6, e19590.CrossRefGoogle Scholar
Cohn, TA, Sernyak, MJ (2006). Metabolic monitoring for patients treated with antipsychotic medications. Canadian Journal of Psychiatry 51, 492–501.CrossRefGoogle ScholarPubMed
Dinan, TG (2004). Stress and the genesis of diabetes mellitus in schizophrenia. British Journal of Psychiatry 47, S72–S75.CrossRefGoogle ScholarPubMed
Druss, BG, Rohrbaugh, RM, Levinson, CM, Rosenheck, RA (2001). Integrated medical care for patients with serious psychiatric illness: a randomized trial. Archives of General Psychiatry 58, 861–868.CrossRefGoogle ScholarPubMed
Druss, BG, von Esenwein, SA, Compton, MT, Rask, KJ, Zhao, L, Parker, RM (2010). A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study. American Journal of Psychiatry 167, 151–159.CrossRefGoogle ScholarPubMed
Frayne, SM, Halanych, JH, Miller, DR, Wang, F, Lin, H, Pogach, Letal. (2005). Disparities in diabetes care: impact of mental illness. Archives of Internal Medicine 165, 2631–2638.CrossRefGoogle ScholarPubMed
Goldman, LS (1999). Medical illness in patients with schizophrenia. Journal of Clinical Psychiatry 60 (Suppl. 21), 10–15.Google ScholarPubMed
Laursen, TM, Munk-Olsen, T, Agerbo, E, Gasse, C, Mortensen, PB (2009). Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Archives of General Psychiatry 66, 713–720.CrossRefGoogle ScholarPubMed
McCreadie, RG (2003). Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study. British Journal of Psychiatry 183, 534–539.Google ScholarPubMed
Millar, HL (2010). Development of a health screening clinic. European Psychiatry 25 (Suppl. 2), S29–S33.CrossRefGoogle ScholarPubMed
Morgan, MG, Scully, PJ, Youssef, HA, Kinsella, A, Owens, JM, Waddington, JL (2003). Prospective analysis of premature mortality in schizophrenia in relation to health service engagement: a 7.5-year study within an epidemiologically complete, homogeneous population in rural Ireland. Psychiatry Research 117, 127–135.CrossRefGoogle ScholarPubMed
Newcomer, JW (2007). Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. Journal of Clinical Psychiatry 68 (Suppl. 1), 20–27.Google ScholarPubMed
NICE (2009). Schizophrenia (Update): NICE Guideline. NICE: London.Google Scholar
Roberts, L, Roalfe, A, Wilson, S, Lester, H (2007). Physical health care of patients with schizophrenia in primary care: a comparative study. Family Practice 24, 34–40.CrossRefGoogle ScholarPubMed
Saha, S, Chant, D, McGrath, J (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry 64, 1123–1131.CrossRefGoogle ScholarPubMed
Taylor, D, Paton, C, Kapur, S (2010). Maudsley Prescribing Guidelines, 10th edn. Informa Healthcare: London.Google Scholar
Tedstone Doherty, D, Moran, R, Kartalova O'Doherty, Y (2008). Psychological Distress, Mental Health Problems and use of Health Services in Ireland. Dublin Health Research Board: Dublin.Google Scholar
Thakore, JH (2004). Metabolic disturbance in first-episode schizophrenia. British Journal of Psychiatry 47, S76–S79.CrossRefGoogle ScholarPubMed
Tiihonen, J, Wahlbeck, K, Lonnqvist, J, Klaukka, T, Ioannidis, JP, Volavka, Jetal. (2006). Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ 333, 224.CrossRefGoogle Scholar