(01) Intervention to improve the rate of metabolic monitoring and prevent the metabolic syndrome associated with the use of atypical antipsychotics

ABSTRACT:

Background: Atypical antipsychotics are mainly used in the treatment of psychiatric disorders and are associated with a range of metabolic disturbances such as weight gain, diabetes, and abnormal lipid levels necessitating careful monitoring. However, adherence to treatment, monitoring, and subsequently health outcomes, are generally poor.

Objectives: To identify the challenges in metabolic monitoring of atypical antipsychotics from the practitioner's and patient’s perspective through qualitative interviews and development and implementation of a key intervention for metabolic monitoring that targets the practitioners and patients.

Methods: In-depth semi-structured interviews were conducted across 4 study sites in South India with 29 purposively sampled participants, (n = 20 patients prescribed atypical antipsychotics, n = 9 psychiatrists directly involved in providing care for the patient participants). Participants were encouraged to share their experiences with SGAs and with metabolic monitoring. Thematic analysis was undertaken, informed by an inductive approach. NVivo software was used to manage the data. Based on the themes from the interviews, metabolic monitoring offline tool was developed to improve the metabolic monitoring rate. Patients’ demographics and medication details were entered in this tool by the investigator at the baseline visit. This tool will allow the psychiatrists’/researcher to monitor the patients’ metabolic parameters at baseline and subsequent visits. Based on the baseline visit date of the patient, reminders were sent to patients and psychiatrists informing the next visit date and the test for metabolic parameters. To check the feasibility of this intervention, a randomized controlled trial was conducted. Patients were stratified based on age, gender, diagnosis, and duration of treatment from which they were selected randomly. The intervention group was provided with metabolic monitoring offline tool and the control group was not provided any interventions. The rate of monitoring in the intervention group was compared to the control group after a period of 3 months.
 

Results: From the patients’ perspectives, medication side effects, lack of awareness about metabolic monitoring, and financial constraints negatively impacted ongoing care and subsequently, health outcomes. From psychiatrists’ perspectives, the interplay of patient-related factors, time constraints, limited hospital resources, and lack of standardized guidelines for patient management negatively impacted their ability to the metabolic monitoring. The patients felt that awareness of the medication side effects and regular monitoring would be helpful to deal with the adverse effects associated with the atypical antipsychotics. Based on these themes, we developed metabolic monitoring offline tool along with reminders for monitoring through SMS. A total of 24 patients (12 in intervention and 12 in control) were included for pilot testing of the tool. The rate of monitoring for metabolic parameters in the intervention group showed better monitoring at baseline (91.7 %) and subsequent visit in 3rd month (75 %) compared to the control group where at baseline there was no monitoring at all and subsequent visit showed monitoring of 8.3 %.
 

Conclusion:  The development of strategies to enhance the practice of metabolic monitoring will allow early detection and timely management of metabolic syndrome which subsequently may improve outcomes for patients who are prescribed atypical antipsychotics.