1 Department of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario.
2 Department of Psychiatry, Queen's University, Kingston, Ontario.
Can J Psychiatry. 2018 Apr;63(4):240-249. doi: 10.1177/0706743717751693. Epub 2018 Mar 11.
Children and adolescents with a range of psychiatric disorders are increasingly being prescribed atypical or second-generation antipsychotics (SGAs). While SGAs are effective at treating conduct and behavioural symptoms, they infer significant cardiometabolic risk. This study aims to explore what patient, treatment, and health care utilization variables are associated with adherence to Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) metabolic monitoring guidelines.
A retrospective chart review of 294 children and adolescents accessing a large outpatient psychiatry setting within a 2-year study period (2014-2016) was conducted. Baseline and follow-up metabolic monitoring, demographic, treatment, and health care utilization variables were then assessed over a 1-year period of interest.
Metabolic monitoring practices did not adhere to CAMESA guidelines and were very poor over the 1-year observation period. There were significant differences between children (ages 4-12 years, n = 99) and adolescents (ages 13-18 years, n = 195). In adolescents, factors associated with any baseline metabolic monitoring were a higher number of psychiatry visits (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.10 to 1.41), longer duration of contact (OR, 14; 95% CI, 2.31 to 82.4), and use of other non-SGA medications (OR, 3.2; 95% CI, 1.17 to 8.94). Among children, having an emergency room visit (OR, 3.4; 95% CI, 1.01 to 11.71) and taking aripiprazole (OR, 7.4; 95% CI, 2.02 to 27.45) increased the odds of receiving baseline metabolic monitoring.
Findings from this study highlight the need for better metabolic monitoring for children and adolescents taking SGAs. Enhanced focus on opportunities for multidisciplinary collaboration is needed to improve the quality of care offered to this population.
患有多种精神疾病的儿童和青少年越来越多地被开处非典型或第二代抗精神病药物（SGAs）。虽然 SGAs 在治疗行为和行为症状方面非常有效，但它们会带来重大的代谢风险。本研究旨在探讨哪些患者、治疗和医疗保健利用变量与加拿大监测抗精神病药疗效和安全性联盟（CAMESA）的代谢监测指南相关。
对 294 名在 2 年研究期间（2014-2016 年）内到大的门诊精神病学环境就诊的儿童和青少年进行了回顾性图表审查。然后，在为期 1 年的观察期间评估了基线和随访的代谢监测、人口统计学、治疗和医疗保健利用变量。
代谢监测实践不符合 CAMESA 指南，在 1 年的观察期间非常差。在 4-12 岁的儿童（n = 99）和 13-18 岁的青少年（n = 195）之间存在显著差异。在青少年中，与任何基线代谢监测相关的因素是更多的精神病学就诊次数（比值比 [OR]，1.2；95%置信区间 [CI]，1.10 至 1.41）、更长的接触时间（OR，14；95% CI，2.31 至 82.4）和使用其他非 SGA 药物（OR，3.2；95% CI，1.17 至 8.94）。在儿童中，急诊就诊（OR，3.4；95% CI，1.01 至 11.71）和服用阿立哌唑（OR，7.4；95% CI，2.02 至 27.45）增加了接受基线代谢监测的可能性。
本研究的结果强调了需要更好地监测服用 SGAs 的儿童和青少年的代谢情况。需要更加强调多学科合作的机会，以提高为这一人群提供的护理质量。
