Monitoring Metabolic Side Effects when Initiating Treatment with Second-Generation Antipsychotic Medication

Abstract

Published guidelines recommend metabolic monitoring for patients prescribed second-generation antipsychotic (SGA) medications. This study determined monitoring rates, and examined predictors of monitoring, for total cholesterol and weight among patients prescribed SGAs during a period when awareness of metabolic side effects was emerging, but prior to the wide promulgation of guidelines. This retrospective study used administrative data from four Veterans Health Administration facilities to examine monitoring rates for total cholesterol and weight during baseline and follow-up periods from October 1, 2000-September 30, 2003 among patients with schizophrenia initiating SGA treatment. The study used logistic regression to identify characteristics that predicted monitoring. Background monitoring rates during routine care were estimated using a resampling procedure. Initiating SGA treatment did not appear to trigger annual monitoring above estimated background rates of 54% for total cholesterol and 47% for weight. Patients with metabolic risk factors were monitored at higher rates independent of the start of treatment with an SGA. This paper provides a window into side effect monitoring practices prior to the widespread promulgation of guidelines and associated quality improvement efforts and serves as a benchmark for future interventions. Prior to publication of monitoring guidelines, patients initiating treatment with SGAs did not receive adequate metabolic monitoring routinely, nor did SGA treatment appear to trigger additional monitoring. Some studies that have assessed the impact of monitoring guidelines on clinical practice show only limited impact. Quality improvement strategies to increase metabolic monitoring over the rates seen here and in other studies should be developed and implemented.