Improving Compliance With Antipsychotic Monitoring in the Psychiatric Population

Psychiatric patients often die earlier than other patients and this is normally due to very treatable illnesses, not their mental illness. One such illness is metabolic syndrome, a cluster of risk factors that can pave the way to diabetes and heart disease. It is well documented in the literature that metabolic syndrome is often a consequence of antipsychotic medications used to treat a variety of mental health conditions. National agencies have recognized this risk of development of metabolic syndrome and have developed consensus guidelines for mental health providers to follow as they screen these patients at designated intervals for early signs of metabolic syndrome. In clinical practice however, there are many barriers to this routine follow-up. This practice may become neglected, as the provider spends time engaging in other activities which will directly affect their reimbursement, such as efforts to demonstrate meaningful use (making sure a PHQ9 is performed at every visit or printing an after visit summary). Subsequently, providers may not have the time to research and identify the last time their patients had suggested laboratory and assessment surveillance for metabolic syndrome completed. It also takes time to measure waist circumference and enter labs into an electronic medical record or ordering system. These particular activities may take time away from the patient. The provider will have less time to listen to the patient’s complaints with regard to problems in their life that they may need to talk about. The patient may have other issues surrounding their mental illness to discuss. Providers may find themselves in a position where they have to choose between competing priorities such as complying with meaningful use, monitoring for the risks associated with metabolic syndrome secondary to antipsychotic medications, or taking the time to actively listen to the patient. One suggested way to improve compliance with this monitoring among mental health providers is through the use of an electronic reminder system, built in to an existing electronic medical record system. It is hypothesized that use of this system will allow clinicians to do a better job of catching metabolic syndrome early. This will lead to early intervention and treatment for these patients thereby reducing morbidity and mortality in this already at-risk population.