School of Pharmacy, University of Birmingham, Birmingham, UK.
Clinical Pharmacy Department, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia.
BMC Psychiatry. 2020 Dec 4;20(1):581. doi: 10.1186/s12888-020-02990-6.
The use of atypical antipsychotics which currently form the primary choice pharmacotherapy for several mental health conditions have been linked to cardiovascular and metabolic side effects. This systematic review aimed to investigate the barriers to monitoring and management of cardiovascular co-morbidities in patients prescribed antipsychotic medicines.
A protocol-led (CRD-42018106002) systematic literature review was conducted by searching Medline, Embase, and PsycINFO databases 2003 until October 2019. Cochrane, Centre for Review and Dissemination (CRD) and PRISMA guidelines were followed. Studies investigating barriers to monitoring and management of cardiovascular co-morbidities in patients prescribed antipsychotic medicines were included.
A total of 23 records were included. Key barriers included a) health-care system-related factors such as lack of knowledge and expertise amongst care providers, available resources, confusion around remit and roles, fragmentation of care such as across general practitioners and psychiatrists, and time constraints and b) patient-related factors such as disability resulting from mental health conditions, knowledge and skills of the patients.
Barriers to monitoring and management of cardiovascular and metabolic health of patients taking antipsychotic medicines are multidimensional. Apart from educational interventions directed to both patients and health-care professionals, the results suggest a need for the improvement of wider system-related factors to improve physical health of patients prescribed antipsychotic medicines. Clearer guidelines, clarity of remit and roles amongst service providers are necessary in addition to educational interventions directed at patients and health-care professionals in improving physical health monitoring, counselling and management of patients prescribed antipsychotic medicines.
A protocol was developed and registered with PROSPERO as per PRISMA-P guidelines ( CRD 42018106002 ).
目前，几种精神健康状况的主要选择药物治疗都使用了非典型抗精神病药物，这些药物与心血管和代谢副作用有关。本系统评价旨在调查监测和管理接受抗精神病药物治疗的患者心血管合并症的障碍。
通过搜索 Medline、Embase 和 PsycINFO 数据库，进行了基于方案的（CRD-42018106002）系统文献综述，检索范围为 2003 年至 2019 年 10 月。遵循 Cochrane、中心审查和传播（CRD）和 PRISMA 指南。纳入了研究抗精神病药物治疗患者心血管合并症监测和管理障碍的研究。
共纳入 23 项记录。主要障碍包括：a）医疗保健系统相关因素，如护理提供者缺乏知识和专业知识、可用资源、职权和角色混淆、全科医生和精神科医生之间的护理碎片化以及时间限制；b）患者相关因素，如精神健康状况导致的残疾、患者的知识和技能。
监测和管理服用抗精神病药物患者心血管和代谢健康的障碍是多方面的。除了针对患者和医疗保健专业人员的教育干预外，结果还表明需要改善更广泛的系统相关因素，以改善服用抗精神病药物的患者的身体健康。除了针对患者和医疗保健专业人员的教育干预外，还需要明确服务提供者的职权和角色，以及在改善身体健康监测、咨询和管理方面的更清晰的指南。
根据 PRISMA-P 指南（CRD42018106002）制定并向 PROSPERO 注册了方案。
