Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052 , Australia.
Aust N Z J Psychiatry. 2011 Sep;45(9):740-8. doi: 10.3109/00048674.2011.595370. Epub 2011 Aug 10.
International guidelines recommend monitoring for weight gain and metabolic disturbance in patients prescribed second generation antipsychotics. We aimed to investigate whether a targeted intervention could improve levels of monitoring in a first episode psychosis clinic.
A pre-intervention audit of both metabolic screening rates and specific monitoring of weight and metabolic indices following the initiation of antipsychotic medication was performed in our first episode psychosis clinic. This was repeated 18 months later, following an intervention that included a number of targeted improvement strategies based on an analysis of barriers and enablers to performing monitoring within the clinic. The intervention included provision of monitoring equipment, interactive educational events, reminders and prompts and embedding processes for monitoring within team structure.
There were significant improvements in both the screening of metabolic indices and the monitoring of indices following initiation of antipsychotic medications. There were also improvements in the number of active interventions offered to clients by clinicians. However, the level of guideline concordant monitoring remains low within our service.
A comprehensive programme of implementation strategies can improve both screening and monitoring of the metabolic side-effects of antipsychotic medications. Further focused strategies are necessary to continue to improve monitoring to guideline concordant levels.
国际指南建议监测服用第二代抗精神病药物的患者体重增加和代谢紊乱情况。我们旨在研究针对性干预措施是否可以改善首发精神病诊所的监测水平。
对首发精神病诊所进行了一项针对代谢筛查率以及在开始使用抗精神病药物后体重和代谢指标的具体监测的干预前审核。18 个月后，在一项干预措施之后再次进行了审核，该干预措施包括了基于分析在诊所内进行监测的障碍和促进因素而制定的多项有针对性的改进策略。干预措施包括提供监测设备、互动教育活动、提醒和提示以及在团队结构中嵌入监测流程。
代谢指标的筛查和抗精神病药物起始后指标的监测均有显著改善。临床医生为患者提供的积极干预措施数量也有所增加。然而，我们的服务中指南一致的监测水平仍然较低。
全面的实施策略方案可以改善抗精神病药物代谢副作用的筛查和监测。需要进一步采取有针对性的策略来继续提高监测水平，以达到指南一致的标准。
