Dhamane Amol D, Martin Bradley C, Brixner Diana I, Hudson Teresa J, Said Qayyim
DHAMANE: Boehringer Ingelheim, Ridgefield, CT; MARTIN, HUDSON, and SAID: University of Arkansas for Medical Sciences, Little Rock, AR; BRIXNER: University of Utah, Salt Lake City, UT.
J Psychiatr Pract. 2013 Sep;19(5):360-74. doi: 10.1097/01.pra.0000435035.45308.03.
This study evaluated how clinicians monitored glucose, lipids, body mass index (BMI), and blood pressure (BP) of patients being treated with second-generation antipsychotics (SGAs) before and after the publication of the American Diabetes Association (ADA) and American Psychiatric Association (APA) Consensus Statement concerning antipsychotic drugs and obesity and diabetes in February, 2004.
A retrospective analysis of GE Centricity electronic health records for the 2001-2008 period was conducted. SGA-naïve patients receiving monotherapy with any SGA (aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone) were identified. Two scenarios were examined: The "Any" monitoring scenario was defined as at least one instance of monitoring of a parameter at any time point during the observation period (from 30 days before beginning the SGA until 395 days after beginning the SGA); the "Full" monitoring scenario was defined as a situation in which the number of times a parameter was monitored during the observation period was equal to the yearly frequency recommended by ADA/APA. Pre- and post-consensus statement monitoring rates were computed and monitoring trends were evaluated by quarterly time intervals using segmented time-series design.
The final sample consisted of 24,826 patients, with mean age of 47.9 years, 61% of whom were female. Pre- and post- consensus statement monitoring compared as following: "Any" scenario: BP (92% [pre] vs. 94% [post]), BMI (66% vs. 77%), glucose (60% vs. 65%), lipids (36% vs. 41%); "Full" scenario; BP (72% vs. 75%), BMI (23% vs. 27%), glucose (23% vs. 27%), lipids (17% vs. 20%). Regression analyses found the following per quarter increases in the post-con- sensus statement period for the "Any" scenario: glucose (1.4%, p = 0.003), lipids (1.0%, p = 0.008), BP (0.6%, p = 0.006) and the following per quarter increases for the "Full" scenario: glucose (1.0%, p = 0.002), lipids (1.2%, p < 0.001) and BP (1.3%, p = 0.004).
The publication of the Consensus Statement alone did not make a clinically meaningful difference to monitoring rates.
本研究评估了在2004年2月美国糖尿病协会（ADA）和美国精神病学协会（APA）发表关于抗精神病药物与肥胖及糖尿病的共识声明前后，临床医生对接受第二代抗精神病药物（SGA）治疗患者的血糖、血脂、体重指数（BMI）和血压（BP）的监测情况。
对2001 - 2008年期间GE Centricity电子健康记录进行回顾性分析。确定接受任何一种SGA（阿立哌唑、氯氮平、奥氮平、喹硫平、利培酮、齐拉西酮）单药治疗且未使用过SGA的患者。研究了两种情况：“任意”监测情况定义为在观察期（从开始使用SGA前30天至开始使用SGA后395天）内任何时间点至少有一次对某一参数的监测；“全面”监测情况定义为观察期内某一参数的监测次数等于ADA/APA推荐的年度监测频率。计算共识声明前后的监测率，并使用分段时间序列设计按季度时间间隔评估监测趋势。
最终样本包括24,826名患者，平均年龄47.9岁，其中61%为女性。共识声明前后的监测情况如下：“任意”情况：血压（92%[前]对94%[后]），BMI（66%对77%），血糖（60%对65%），血脂（36%对41%）；“全面”情况：血压（72%对75%），BMI（23%对27%），血糖（23%对27%），血脂（17%对20%）。回归分析发现，在共识声明发布后的“任意”情况下，每季度各参数的增加情况如下：血糖（1.4%，p = 0.003），血脂（1.0%，p = 0.008），血压（0.6%，p = 0.006）；“全面”情况下每季度各参数的增加情况如下：血糖（1.0%，p = 0.002），血脂（1.2%，p < 0.001），血压（1.3%，p = 0.004）。
仅共识声明的发布对监测率并未产生具有临床意义的差异。
