Managing antipsychotics' metabolic side effects
November 9, 2009
More than 8 in 10 VA patients with
schizophrenia or other psychotic
disorders are prescribed a class of drugs
known as second-generation antipsychotics.
The drugs are considered an improvement
over earlier medications that often caused
muscle stiffness, spasms and other troubling
side effects. But the newer drugs come with
side effects of their own—weight gain,
diabetes, high cholesterol.
A 2007 VA report and other research
suggested VA doctors could do a better job
of tracking and managing the side effects of
second-generation antipsychotics. In
response, VA's Office of Mental Health
Services set up a workgroup to enact a
wide-ranging set of recommendations.
A new study based at the Central
Arkansas Veterans Healthcare System will
add to those efforts. "We anticipate that
national implementation of these
recommendations will improve care overall,
but the improvement is likely to be less
pronounced at a substantial number of
facilities that are 'stressed,'" explains study
leader Richard Owen, MD, director of VA's
Center for Mental Healthcare and Outcomes
Research. "These are facilities with fewer
resources and more difficulty undertaking
quality-improvement efforts."
Owen's team will test a targeted qualityimprovement
intervention at those sites.
Clinicians and leadership at each facility
will be kept abreast of the latest research
evidence; develop their own plan to monitor
and better manage side effects, with help
from the researchers; and be given access to
quality improvement tools such as VA Department
of Defense clinical practice
guidelines and supporting materials;
educational pocket-sized cards for
effects; clinical reminders in patients'
individual electronic medical records; and
computer-generated lists for providers that
identify all of their patients who are due for
side-effect monitoring.
Owen says one overarching goal will be
enhancing coordination between primary
care and mental health clinics.
To measure improvement, the
researchers will track the rates at which care
teams check patients' weight, body mass
index, blood glucose levels and cholesterol
levels, and the extent to which patients who
are obese or who have diabetes or high
cholesterol receive interventions consistent
with VA guidelines.
This article originally appeared in the Nov-Dec 2009 issue of VA Research Currents.