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BACKGROUND/RATIONALE:
The introduction of a second generation of antipsychotic medications has offered new treatment options in general, with lower risk of adverse neurologic effects. Unfortunately, treatment with many of these medications is associated with risk of weight gain, diabetes, and hyperlipidemia. The impact on patient safety and health outcomes due to lack of monitoring and management of these side effects is potentially devastating. A number of VA networks have implemented educational or quality improvement initiatives to improve side effect monitoring, and our recent multi-site study demonstrated that a multi-component intervention can improve monitoring. However, little is known about the extent to which patients with observed metabolic abnormalities receive timely and evidence-based interventions to address these side effects. Research is needed to determine the extent and nature of deviations from evidence-based management of metabolic side effects of antipsychotics so that interventions can be developed to address deficiencies. This study will examine current practices for management of metabolic side effects, as well as determine the extent to which patient characteristics, such as comorbidities, affect rates of side effect monitoring and management. The results will be used to inform development of interventions to improve monitoring and management.
OBJECTIVE(S):
Specific Aims include: 1) to determine the extent to which patients who develop metabolic side effects during antipsychotic treatment receive guideline-concordant management of these side effects and 2) to identify patient characteristics that affect the likelihood of receiving recommended side effect monitoring and management.
METHODS:
Methods will include analysis of data extracted from the VISN 16 data warehouse, and from a regional data warehouse (Region 1) available through the Office of Research & Developments Center for Scientific Computing that includes data from 31 VAMCs in VISNs 18-22, to determine the prevalence and correlates of metabolic side effects of antipsychotics, and the extent to which these side effects are managed as recommended by VHA clinical practice guidelines for obesity, diabetes, and dyslipidemias. The study will be conducted using data from FY06 and FY07 extracted from the two data sources. Inclusion criteria will be similar to those we have used in previous studies. Data will be extracted for all patients that receive three or more prescriptions for antipsychotic medications in FY07 and that receive a prescription for a new or different antipsychotic during FY07.
FINDINGS/RESULTS:
None at this time.
IMPACT:
The project will serve two major purposes: results will inform site selection and intervention development for a Service Directed Project to be submitted in 2008, and the study will fill an important gap in knowledge of current management practices.
PUBLICATIONS:
None at this time.
DRA:
Mental Illness
DRE:
none
Keywords:
none
MeSH Terms:
none
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