School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112, USA.
BMC Psychiatry. 2009 Dec 18;9:80. doi: 10.1186/1471-244X-9-80.
To examine the baseline metabolic monitoring (MetMon) for second generation antipsychotics (SGA) among patients with schizophrenia in the Veterans Integrated Service Network (VISN) 16 of the Veterans Health Administration (VHA).
VISN16 electronic medical records for 10/2002-08/2005 were used to identify patients with schizophrenia who received a new episode of SGA treatment after 10/2003, in which the VISN 16 baseline MetMon program was implemented. Patients who underwent MetMon (MetMon+: either blood glucose or lipid testing records) were compared with patients who did not (MetMon-), on patient characteristics and resource utilization in the year prior to index treatment episode. A parsimonious logistic regression was used to identify predictors for MetMon+ with adjusted odds ratios (OR) and 95% confidence intervals (CI).
Out of 4,709 patients, 3,568 (75.8%) underwent the baseline MetMon. Compared with the MetMon- group, the MetMon+ patients were found more likely to have baseline diagnoses or mediations for diabetes (OR [CI]: 2.336 [1.846-2.955]), dyslipidemia (2.439 [2.029-2.932]), and hypertension (1.497 [1.287-1.743]), substance use disorders (1.460 [1.257-1.696]), or to be recorded as obesity (2.052 [1.724-2.443]). Increased likelihood for monitoring were positively associated with number of antipsychotics during the previous year (FGA: 1.434 [1.129-1.821]; SGA: 1.503 [1.290-1.751]). Other significant predictors for monitoring were more augmentation episodes (1.580 [1.145-2.179]), more outpatient visits (1.007 [1.002-1.013])), hospitalization days (1.011 [1.007-1.015]), and longer duration of antipsychotic use (1.001 [1.001-1.001]). Among the MetMon+ group, approximately 38.9% patient had metabolic syndrome.
This wide time window of 180 days, although congruent with the VHA guidelines for the baseline MetMon process, needs to be re-evaluated and narrowed down, so that optimally the monitoring event occurs at the time of receiving a new episode of SGA treatment. Future research will examine whether or not patients prescribed an SGA are assessed for metabolic syndrome following the index episode of antipsychotic therapy, and whether or not such baseline and follow-up monitoring programs in routine care are cost-effective.
The baseline MetMon has been performed for a majority of the VISN 16 patients with schizophrenia prior to index SGA over the study period. Compared with MetMon- group, MetMon+ patients were more likely to be obese and manifest a more severe illness profile.
本研究旨在考察退伍军人事务部医疗保健系统（VHA）第 16 退伍军人综合服务网（VISN）中第二代抗精神病药物（SGA）的基线代谢监测（MetMon）情况。
我们使用 VISN16 的电子病历数据，于 2002 年 10 月至 2005 年 8 月间，确定了在 2003 年 10 月后接受新发作 SGA 治疗的精神分裂症患者。在此期间，VISN16 实施了基线 MetMon 计划。我们比较了接受 MetMon（MetMon+：血糖或血脂检测记录）和未接受 MetMon（MetMon-）的患者在索引治疗前一年的患者特征和资源利用情况。采用简约逻辑回归确定基线 MetMon+的预测因素，计算调整后的优势比（OR）和 95%置信区间（CI）。
在 4709 名患者中，有 3568 名（75.8%）接受了基线 MetMon。与 MetMon-组相比，MetMon+患者基线诊断或合并糖尿病（OR [CI]：2.336 [1.846-2.955]）、血脂异常（2.439 [2.029-2.932]）、高血压（1.497 [1.287-1.743]）、物质使用障碍（1.460 [1.257-1.696]）的可能性更高，或被记录为肥胖（2.052 [1.724-2.443]）。监测的可能性与前一年使用的抗精神病药物数量呈正相关（FGA：1.434 [1.129-1.821]；SGA：1.503 [1.290-1.751]）。其他显著的监测预测因素包括更多的增效治疗发作（1.580 [1.145-2.179]）、更多的门诊就诊次数（1.007 [1.002-1.013]）、住院天数（1.011 [1.007-1.015]）和更长的抗精神病药物使用时间（1.001 [1.001-1.001]）。在 MetMon+组中，约 38.9%的患者患有代谢综合征。
虽然本研究中 180 天的宽时间窗口与 VHA 基线 MetMon 过程的指南一致，但需要重新评估和缩小，以便最佳情况下监测事件发生在接受新的 SGA 治疗发作时。未来的研究将检查在接受抗精神病药物治疗的索引发作后，是否对处方 SGA 的患者进行代谢综合征评估，以及常规护理中的这种基线和随访监测计划是否具有成本效益。
在研究期间，VISN16 大多数精神分裂症患者在接受新的 SGA 治疗前都进行了基线 MetMon。与 MetMon-组相比，MetMon+患者更可能肥胖，并表现出更严重的疾病特征。
