The effect of a computerized best practice alert system in an outpatient setting on metabolic monitoring in patients on second‐generation antipsychotics
dc.contributor.author | Cohen, Sydnee | |
dc.contributor.author | Bostwick, Jolene R. | |
dc.contributor.author | Marshall, Vincent D. | |
dc.contributor.author | Kruse, Kathleen | |
dc.contributor.author | Dalack, Gregory W. | |
dc.contributor.author | Patel, Paresh | |
dc.date.accessioned | 2020-12-02T14:38:45Z | |
dc.date.available | WITHHELD_13_MONTHS | |
dc.date.available | 2020-12-02T14:38:45Z | |
dc.date.issued | 2020-12 | |
dc.identifier.citation | Cohen, Sydnee; Bostwick, Jolene R.; Marshall, Vincent D.; Kruse, Kathleen; Dalack, Gregory W.; Patel, Paresh (2020). "The effect of a computerized best practice alert system in an outpatient setting on metabolic monitoring in patients on second‐generation antipsychotics." Journal of Clinical Pharmacy and Therapeutics 45(6): 1398-1404. | |
dc.identifier.issn | 0269-4727 | |
dc.identifier.issn | 1365-2710 | |
dc.identifier.uri | https://hdl.handle.net/2027.42/163603 | |
dc.description.abstract | What is known and objectiveMetabolic syndrome is a well‐documented adverse effect of second‐generation antipsychotics (SGAs). Patients with metabolic syndrome are at an increased risk of potentially fatal cardiovascular events, including myocardial infarction and stroke. This elevated risk prompted the creation of a national guideline on metabolic monitoring for patients on SGAs in 2004. However, monitoring practices remained low at our clinic. To address this concern, a clinical decision support system was developed to alert providers of monitoring requirements. The purpose of this study is to determine the effect of the best practice alert (BPA), and to assess the impact of provider and patient characteristics on metabolic laboratory (lab) order rates.MethodsA retrospective chart review was conducted at a large outpatient psychiatric clinic. Data were collected from all adult patients who were prescribed an SGA and triggered the BPA (indicating lab monitoring is needed for the patient). Data collection included a variety of patient, provider and alert variables. The primary outcome was a composite of fasting blood glucose (FBG), haemoglobin A1c (HbA1c) and/or fasting lipid panel order rates. Secondary outcomes included the rate of valid response, which considered appropriate reasons for not ordering labs (ie monitoring already completed during recent primary care visit), as well as order rates of individual labs.Results and DiscussionData from 1112 patients were collected and analysed. Patients with a thought disorder diagnosis had significantly more labs ordered than those without. No other patient factors affected order rates. Resident psychiatrists and nurse practitioners ordered significantly more labs and had significantly more valid responses than attending psychiatrists. An active alert, which fired during medication order entry, was associated with a higher rate of lab ordering and valid response compared to a passive alert, which fired whenever a prescribing healthcare provider opened the chart.What is new and conclusionPrescribers may associate metabolic syndrome with schizophrenia or with use of SGAs specifically in thought disorders, even though these medications pose a risk for all indications. Higher rates of monitoring by resident physicians may have been due to spending more time with patients during the encounter and in documentation. Lastly, the active BPA was an effective tool to increase metabolic monitoring in patients taking SGAs. Continued education on the importance of regular metabolic monitoring should be implemented for all providers. | |
dc.publisher | Wiley Periodicals, Inc. | |
dc.subject.other | atypical antipsychotics | |
dc.subject.other | clinical pharmacy | |
dc.subject.other | computerized decision support system | |
dc.subject.other | best practice alert | |
dc.subject.other | second‐generation antipsychotics | |
dc.subject.other | metabolic syndrome | |
dc.subject.other | metabolic monitoring | |
dc.title | The effect of a computerized best practice alert system in an outpatient setting on metabolic monitoring in patients on second‐generation antipsychotics | |
dc.type | Article | |
dc.rights.robots | IndexNoFollow | |
dc.subject.hlbsecondlevel | Pharmacy and Pharmacology | |
dc.subject.hlbtoplevel | Health Sciences | |
dc.description.peerreviewed | Peer Reviewed | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/163603/2/jcpt13236_am.pdf | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/163603/1/jcpt13236.pdf | en_US |
dc.identifier.doi | 10.1111/jcpt.13236 | |
dc.identifier.source | Journal of Clinical Pharmacy and Therapeutics | |
dc.identifier.citedreference | Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med Sept. 2005; 353: 1209 ‐ 1223. | |
dc.identifier.citedreference | Arana GW. An overview of side effects caused by typical antipsychotics. J Clin Psychiatry. 2000; 61 ( suppl 8 ): 5 ‐ 11. | |
dc.identifier.citedreference | Consensus Statement. Consensus development conference on antipsychotic drugs and obesity and diabetes. J Clin Psychiatry, 2004; 65 ( 2 ): 267 ‐ 272. | |
dc.identifier.citedreference | Vancampfort D, Stubbs B, Mitchell AJ, et al. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta‐analysis. World Psychiatry. 2015; 14 ( 3 ): 339 ‐ 347. | |
dc.identifier.citedreference | Poker LM, Chrymko MM, Bostwick JR. Electronic order set and reminders significantly improve ordering of monitoring parameters for antipsychotic medications. Fed Pract. 2010; 27 ( 8 ): 9 ‐ 14. | |
dc.identifier.citedreference | Lee J, Dalack GW, Casher MI, Eappen SA, Bostwick JR. Persistence of metabolic monitoring for psychiatry inpatients treated with second‐generation antipsychotics utilizing a computer‐based intervention. J Clin Pharm Ther Feb. 2016; 41: 209 ‐ 213. | |
dc.identifier.citedreference | American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004; 27 ( 2 ): 596 ‐ 601. | |
dc.identifier.citedreference | Straker D, Correll CU, Kramer‐Ginsberg E, et al. Cost‐effective screening for the metabolic syndrome in patients treated with second‐generation antipsychotic medications. Am J Psychiatry. 2005; 162 ( 6 ): 1217 ‐ 1221. | |
dc.identifier.citedreference | Newcomer JW. Second‐generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs. 2005; 19 ( Suppl 1 ): 1 ‐ 93. | |
dc.identifier.citedreference | Wei Xin Chong J, Hsien‐Jie Tan E, Chong CE, et al. Atypical antipsychotics: a review on the prevalence, monitoring, and management of their metabolic and cardiovascular side effects. Ment Health Clin. 2016; 6 ( 4 ): 178 ‐ 184. | |
dc.identifier.citedreference | National Heart, Lung, and Blood Institute. Metabolic syndrome. https://www.nhlbi.nih.gov/health‐topics/metabolic‐syndrome. Accessed August 2, 2019. | |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
Files in this item
Remediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.