Peña Anita, DeJongh Beth, Haas Matthew, Harms Michelle
Clinical Pharmacist, Aurora Health Care, Milwaukee, Wisconsin,
Mental Health Clinical Pharmacy Specialist, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin; Assistant Professor of Pharmacy Practice, Concordia University Wisconsin School of Pharmacy, Mequon, Wisconsin.
Ment Health Clin. 2018 Mar 26;8(2):49-55. doi: 10.9740/mhc.2018.03.049. eCollection 2018 Mar.
Patients taking second-generation antipsychotics (SGAs) are at increased risk of developing metabolic syndrome because of the side effect profiles of these medications. A medication use evaluation (MUE) was conducted and showed that baseline monitoring rates of metabolic parameters in patients taking SGAs are low. A pharmacist-run metabolic syndrome monitoring clinic (MSMC) is available to mental health (MH) outpatients; however, the clinic is underused by providers. The purpose of this project was to increase baseline metabolic syndrome monitoring rates in patients taking SGAs by implementing interventions to overcome barriers to monitoring and to accessing the MSMC.
Appropriate tools to improve monitoring were obtained, and an electronic consult for the MSMC was created. A presentation and pamphlet were developed to improve awareness. Information about free patient transportation was obtained and distributed. Efficacy was assessed by evaluating patient referrals to the clinic before and after intervention, comparing baseline monitoring rates after implementation with the MUE data, and administering an anonymous survey to outpatient MH providers.
There was a 37.5% increase in overall referral rates to the MSMC after intervention, but only 51.5% of patients attended appointments as scheduled. Monitoring of vital signs increased, but monitoring of laboratory parameters decreased. A total of 60% (9 of 15) of providers completed a survey, of which one third indicated they still forget to refer patients to the MSMC.
Overall, baseline metabolic monitoring rates remained low despite implementing several interventions. Patient and provider outreach is crucial for initiating and maintaining a successful metabolic monitoring system for patients taking SGAs.
由于第二代抗精神病药物（SGA）的副作用，服用这些药物的患者患代谢综合征的风险增加。一项药物使用评估（MUE）显示，服用SGA的患者代谢参数的基线监测率较低。一家由药剂师管理的代谢综合征监测诊所（MSMC）可供心理健康（MH）门诊患者使用；然而，该诊所未得到医疗服务提供者的充分利用。本项目的目的是通过实施干预措施来克服监测障碍和使用MSMC的障碍，从而提高服用SGA患者的基线代谢综合征监测率。
获取了用于改善监测的适当工具，并创建了向MSMC的电子咨询。制作了一份演示文稿和宣传册以提高认识。获取并分发了有关患者免费交通的信息。通过评估干预前后转诊至该诊所的患者情况、将实施后的基线监测率与MUE数据进行比较以及对门诊MH医疗服务提供者进行匿名调查来评估疗效。
干预后转诊至MSMC的总体比率增加了37.5%，但只有51.5%的患者按计划就诊。生命体征监测有所增加，但实验室参数监测有所下降。共有60%（15名中的9名）医疗服务提供者完成了一项调查，其中三分之一表示他们仍然会忘记将患者转诊至MSMC。
总体而言，尽管实施了多项干预措施，基线代谢监测率仍然较低。对患者和医疗服务提供者进行宣传推广对于为服用SGA的患者启动并维持一个成功的代谢监测系统至关重要。
