J Am Pharm Assoc (2003). 2021 Sep-Oct;61(5):e126-e131. doi: 10.1016/j.japh.2021.04.010. Epub 2021 Apr 21.
Second-generation antipsychotics are associated with lower risks of extrapyramidal symptoms, including tardive dyskinesia. However, many second-generation antipsychotics are associated with metabolic adverse effects, including weight gain, impaired blood glucose control, and hyperlipidemia. Metabolic monitoring for patients prescribed antipsychotic medication is 1 of several measures of the Centers for Medicare & Medicaid Services' Inpatient Psychiatric Facility Quality Reporting program. Screening for metabolic disorders (SMD) must be obtained within the previous 365 days before the hospital discharge date. National data suggest that compliance with this measure is low.
To improve compliance of metabolic monitoring by 20% while ensuring that the quality improvement interventions did not cause any unintended adverse effects on other aspects of our system.
This quality initiative was conducted at a large, 2000-bed academic medical center with approximately 80 inpatient psychiatric beds.
To improve the metabolic screening rates, a pharmacist collaborative practice agreement (CPA) was established as part of a quality improvement project. Previously, there were no formal processes at the institution to ensure that appropriate laboratory tests were conducted.
Using an uncontrolled before-and-after design, SMD data were gathered from 6 months before and 6 months after CPA implementation. Pearson chi-square test or Fisher exact test were used to compare the pre- and postintervention groups in this quasi-experimental design.
Compared with the preintervention period, compliance of SMD monitoring increased by 21.2% in the postintervention phase-from 69.2% to 90.4% (P < 0.001).
The empowerment of clinical pharmacists with a CPA significantly improved guideline-concordant metabolic monitoring of antipsychotics. These findings may have significant impact on the approach to the safe use of these essential psychotropic medications and provide a framework for other inpatient mental health facilities to optimally use the skills of their interdisciplinary team.
第二代抗精神病药物与锥体外系症状（包括迟发性运动障碍）的风险降低有关。然而，许多第二代抗精神病药物与代谢不良影响有关，包括体重增加、血糖控制受损和血脂异常。为接受抗精神病药物治疗的患者进行代谢监测是医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）住院精神病院质量报告计划的若干措施之一。代谢紊乱筛查（Screening for metabolic disorders，SMD）必须在住院日期前的过去 365 天内获得。国家数据表明，该措施的依从性较低。
在不造成对系统其他方面的任何意外不良影响的情况下，将代谢监测的依从性提高 20%。
这项质量倡议是在一家拥有 2000 张床位的大型学术医疗中心进行的，该中心约有 80 张住院精神病床位。
为了提高代谢筛查率，作为质量改进项目的一部分，制定了药剂师合作实践协议（Pharmacist collaborative practice agreement，CPA）。在此之前，该机构没有正式程序来确保进行适当的实验室测试。
使用无对照的前后设计，在实施 CPA 前后 6 个月收集 SMD 数据。在这种准实验设计中，使用 Pearson 卡方检验或 Fisher 确切检验比较干预前后组。
与干预前相比，干预后 SMD 监测的依从性从 69.2%提高到 90.4%（P<0.001），提高了 21.2%。
通过 CPA 赋予临床药师权力，显著改善了抗精神病药物的指南一致代谢监测。这些发现可能对这些基本精神药物安全使用的方法产生重大影响，并为其他住院心理健康机构提供了一个框架，以最佳利用其跨学科团队的技能。
