Abstract
AimsTo assess physical health in patients under the Early Intervention Service, whom are prescribed antipsychotics.To consider whether further intervention needs to be provided or promoted to improve physical health in this group.MethodAssessment of carenotes database for all 63 patients on EIS caseload prescribed antipsychotics.ResultOut of 47 patients studied, 20 were non-smokers at baseline. 25% of them ended up becoming smokers by the end of the study time.Out of 47 patients studied 28 were non-drinkers at baseline. 32% of them ended up engaging in alcohol by the end of the study time.Out of 47 patients studied, 38 patients had data available to record weight changes per year. Out of the 38 patients, 27 of them had positive weight change; average weight change was + 6.38 kg per year. The highest weight gain was 38.4 kg, the highest weight lost was 47.3 kg.Out of 47 patients studied, 35 patients had data available to record BMI changes. Out of the 35 patients, 27 of them had positive BMI increases, average BMI change was + 2.68. The highest BMI increase was 12.84. The highest BMI decrease was 8.24.Out of 47 patients studied, 11 patients had data available to record random glucose level changes. Out of the 11 patients, 7 of them had increased glucose levels, average glucose change were + 0.5mmol/l. The highest increase in glucose was 3.9mmol/l and the highest drop in glucose was 2.6mmol/l.Out of 47 patients studied, 19 patients had data available to record HbA1c levels. Out of the 19 patients, 10 of them had increased HbA1c levels, with the average change being + 0.31 mmol/mol. The highest increase in HbA1c levels was 5 mmol/mol and the highest drop in HbA1c levels was 3 mmol/mol.Out of 47 patients studied, 30 patients had data available to record cholesterol changes. Out of the 30 patients, 21 of them had increased cholesterol levels, with the average change being + 0.09mmol/l. The highest increase in cholesterol was 1.7mmol/l and the highest drop in cholesterol levels was 2.6.Taken together, we show that anti-psychotic use has a negative effect on physical health parameters such as weight gain, BMI increase, HbA1c levels and cholesterol levels. This increases the patient's risk of developing diabetes/metabolic syndrome in the future.ConclusionRe-audit.
Highlights
Monitoring being completed but not documented Patients’ refusal of monitoring Data being recorded in alternative locations including general practice, without communication between services Patients moving between teams or having inpatient stays may disrupt monitoring regime Conclusion
Out of 47 patients studied, 20 were non-smokers at baseline. 25% of them ended up becoming smokers by the end of the study time
Out of 47 patients studied 28 were non-drinkers at baseline. 32% of them ended up engaging in alcohol by the end of the study time
Summary
Monitoring being completed but not documented Patients’ refusal of monitoring Data being recorded in alternative locations including general practice, without communication between services Patients moving between teams or having inpatient stays may disrupt monitoring regime Conclusion. LIMITATIONS This audit assumes all patients involved to be on a stable dose of clozapine with routine monitoring Some patients may have been transferred between teams or inpatients during the period of data collection There is no scope to record when patients refuse monitoring We may not have access to all notes such as those from general practice for data collection RECOMMENDATIONS Induction programme for junior doctors to include education on clozapine monitoring Training for staff involved in clozapine clinics to ensure better understanding of monitoring requirements Procurement of ECG machines for each site and relevant training for nursing and medical staff Collaboration with GPs for shared data Re-audit in 1 year Service evaluation of weight gain in patients prescribed antipsychotics within the early intervention service To assess physical health in patients under the Early Intervention Service, whom are prescribed antipsychotics.
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