Metabolic Monitoring of Patients Prescribed Second-Generation Antipsychotics

Objectives. This study evaluated how clinicians monitored glucose, lipids, body mass index (BMI), and blood pressure (BP) of patients being treated with second-generation antipsychotics (SGAs) before and after the publication of the American Diabetes Association (ADA) and American Psychiatric Association (APA) Consensus Statement concerning antipsychotic drugs and obesity and diabetes in February, 2004. Methods. A retrospective analysis of GE Centricity electronic health records for the 2001-2008 period was conducted. SGA-naive patients receiving monotherapy with any SGA (aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone) were identified. Two scenarios were examined: The "Any" monitoring scenario was defined as at least one instance of monitoring of a parameter at any time point during the observation period (from 30 days before beginning the SGA until 395 days after beginning the SGA); the "Full" monitoring scenario was defined as a situation in which the number of times a parameter was monitored during the observation period was equal to the yearly frequency recommended by ADA/APA. Pre- and post-consensus statement monitoring rates were computed and monitoring trends were evaluated by quarterly time intervals using segmented time-series design. Results. The final sample consisted of 24,826 patients, with mean age of 47.9 years, 61% of whom were female. Pre- and post-consensus statement monitoring compared as following: "Any" scenario: BP (92% [pre] vs. 94% [post]), BMI (66% vs. 77%), glucose (60% vs. 65%), lipids (36% vs. 41%); "Full" scenario; BP (72% vs. 75%), BMI (23% vs. 27%), glucose (23% vs. 27%), lipids (17% vs. 20%). Regression analyses found the following per quarter increases in the post-consensus statement period for the "Any" scenario: glucose (1.4%, p = 0.003), lipids (1.0%, p = 0.008), BP (0.6%, p = 0.006) and the following per quarter increases for the "Full" scenario: glucose (1.0%, p = 0.002), lipids (1.2%, p < 0.001) and BP (1.3%, p = 0.004). Conclusions. The publication of the Consensus Statement alone did not make a clinically meaningful difference to monitoring rates.