Abstract
BackgroundAt 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.MethodsIn 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.DiscussionIn 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 registrationMOPHAR research has been prospectively registered with the Netherlands Trial Register on 19th of November 2014. (NL4779).
Highlights
At many outpatient departments for psychiatry worldwide, standardized monitoring of the safety of prescribed psychotropic drugs is not routinely performed in daily clinical practice
In order to address these issues, we developed the innovative monitoring program ‘Monitoring Outcomes of Psychiatric Pharmacotherapy (MOPHAR)’
Psychiatric patients are vulnerable for somatic co-morbidities and side effects of psychotropic medication
Summary
At many outpatient departments for psychiatry worldwide, standardized monitoring of the safety of prescribed psychotropic drugs is not routinely performed in daily clinical practice. Somatic co-morbidities such as cardiovascular disease, nutritional and metabolic diseases and pain may account for approximately two-thirds of this excess mortality [1, 3, 4] This increased somatic morbidity and mortality may be contributed to by various factors, including an unhealthy lifestyle (directly or indirectly associated with psychopathology of the patient) and disparities in health care provision and access, associated with the psychiatric disease [1, 5]. Mood disorders are known to negatively influence lifestyle [7, 8] These disorders are commonly treated with combinations of lithium, mood stabilizers, antipsychotics and antidepressants. These patients are at risk for developing somatic complications too [9, 10]. Psychiatric patients are generally less inclined to use health care services and have a decreased perception of illness compared to the general population [11]
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