Re-implementation of a pharmacist-managed metabolic syndrome clinic in an outpatient mental health clinic setting

Abstract

Introduction: Second-generation antipsychotics (SGA) are often prescribed prior to first-generation antipsychotics (FGA) for mental health disorders by reason of proposed improved tolerability. Patients on SGA are not always appropriately screened for metabolic parameters in the clinical setting. A metabolic clinic was previously established for a limited time period at the West Palm Beach Veterans Affairs Medical Center (WPB VAMC) with beneficial outcomes. Re-implementation expanded the clinic to assess the impact when patients were referred from outpatient mental health and primary care providers. The objectives of this quality improvement initiative were to evaluate pharmacologic and nonpharmacologic interventions and compare the patient load preexpansion and postexpansion of the metabolic clinic. Methods: Patients receiving SGA at the WPB VAMC who met the criteria for metabolic syndrome were referred to the metabolic clinic. Preclinic data variables collected include demographics, social history, SGA, and assessment for presence of hypertension, diabetes, or dyslipidemia. Pharmacologic and nonpharmacologic intervention variables were collected throughout clinic involvement. The patient load post clinic expansion was reported. Results: Of the 17 patients evaluated, 88.2% had hypertension, 94.1% had dyslipidemia, and 88.2% had diabetes mellitus. The average number of components of metabolic syndrome was 3.7 out of 5 possible components. Most patients were taking risperidone (47.1%). An average of 1.5 medication interventions were made per patient. Only 28 patients were referred during reimplementation phase. Discussion: Metabolic syndrome commonly occurs in patients receiving SGA. Appropriately trained clinical pharmacists can help fill a gap in care by providing the recommended monitoring criteria and interventions for patients taking SGA.