Clinical Algorithm and Educational Presentation for the Management of Metabolic Side Effects Associated with Second Generation Antipsychotics

The aim of this project is to develop and provide an educational opportunity in regards to treating the metabolic side effects of second-generation antipsychotic (SGA) medications. Evidence-based resources, as well as VA specific resources, provided content for the development of a clinical algorithm, as well as an educational presentation for prescribers at a local Veterans Affair outpatient mental health clinic. Problem Statement: The metabolic side effects of SGAs can contribute to the development of chronic health problems such as diabetes, cardiovascular disease and stroke. Mental health providers are familiar with the metabolic side effects of SGAs; however, they are generally unprepared to treat these side effects. At a local Veteran Affairs outpatient mental health clinic, mental health prescribers are beginning to take on a greater role in the treatment of metabolic side effects. As such, this project will provide mental health prescribers with an educational opportunity and tools related to the various resources available for treating metabolic side effects. Objectives: The objectives of this project were 1. Reduced incidence of metabolic side effects to promote the health of veterans and reduce costs to the VA. 2. Develop a treatment algorithm utilizing evidence-based literature and VA specific resources. 3. Present treatment algorithm at a monthly prescriber meeting. 4. Obtain feedback on the utility of the treatment algorithm and educational opportunity, as well as concerns for future consideration. Literature Review: SGAs are a highly efficacious medication class, used in the treatment of various mental health disorders such as bipolar spectrum disorders and schizophrenia spectrum disorders. Mental health prescribers commonly use SGAs, but they carry significant risk for metabolic side effects such as weight gain, dyslipidemia and hyperglycemia. Several treatment interventions have demonstrated efficacy in mitigating the development of metabolic side effects. Treatment interventions include dietary modifications, exercise programs, switching agents and medications to treat metabolic disturbances. Implementation & Evaluation: In order to guide mental health providers in treating metabolic side effects of SGAs, the clinical algorithm included information consolidated from the literature review and from VA specific resources and programs available to veterans. Content experts provided recommendations for modifications. At a monthly prescriber meeting, a presentation of the algorithm included in-depth education regarding the treatment of metabolic side effects. A pre- and post-questionnaire provided during the presentation gathered feedback regarding the benefit of the educational presentation and treatment algorithm. Results: Nine mental health APRNs participated (n=9). Following an educational opportunity for treating metabolic side effects of SGAs, the APRNs comfort level and intention to treat increased (17% and 14% respectively); however, the pre- and post- comparison are not statistically significant at a 5% significance level. Summary: There is a need for mental health providers to provide a treatment intervention to their clients who are taking SGAs. This project provides foundational knowledge and resources, allowing mental health providers to mitigate the risk for the development of metabolic side effects.