Improving Adherence to Evidence-Based Metabolic Monitoring for Patients Taking Second Generation Antipsychotics (SGAs) in Primary Care

This project was designed to improve fidelity to ADA/APA metabolic monitoring guidelines for patients taking SGAs. Second Generation Antipsychotics demonstrate a high affinity for serotonin 2c/1a, histamine and muscarinic receptors which frequently lead to dyslipidemia, diabetes, and obesity. As a result, routine monitoring of metabolic markers is essential to prevent potentially devastating long-term outcomes including renal, hepatic, skin, ocular, sleep, reproductive, cardiovascular, and oncogenic systemic pathologies. Despite this, healthcare providers do not always possess knowledge of or routinely follow evidence-based guidelines for monitoring. The objectives of this project included: (a) examining current rates of metabolic monitoring in the outpatient primary care clinics of a local Salt Lake City healthcare system, (b) providing an educational intervention to PCPs focused on evidence-based metabolic monitoring guidelines and use of a new electronic health record clinical reminder, and (c) submission of project outcomes for presentation in a professional forum. Following University of Utah IRB approval, the author collaborated with IT staff to gather baseline data in order to facilitate analysis of initial metabolic monitoring rates for patients taking SGAs in the primary care clinics. Unfortunately, midway through the project, use of the Primary Care Clinic as the intervention site was terminated due to administrative changes. In consultation with the project chair and content expert, arrangements were made to complete the project in the outpatient mental health clinic in the same health care system. Following data revision and re-collection, prescribing providers participated in an educational intervention focused on an overview of evidence-based metabolic monitoring guidelines and use of an electronic health record clinical reminder aimed to increase adherence to screening guidelines. One month post-intervention rates of guideline adherence were then compared to baseline metabolic monitoring rates to assess for any changes in screening adherence. An abstract describing the project and incorporating post-intervention data was produced and submitted for presentation in a professional forum. In summary, this project aimed to educate prescribing clinicians regarding the evidencebased guidelines specific to metabolic monitoring and enhance rates of screening for patients taking SGAs. In doing this, an opportunity is created to reduce disability and create a positive impact on long-term outcomes for a group of frequently neglected patients.