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Brief Reports   |    
Primary Care Providers’ Views on Metabolic Monitoring of Outpatients Taking Antipsychotic Medication
Christina Mangurian, M.D.; Funmi Giwa, B.A.; Martha Shumway, Ph.D.; Elena Fuentes-Afflick, M.D., M.P.H.; Eliseo J. Pérez-Stable, M.D.; James W. Dilley, M.D.; Dean Schillinger, M.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.002542012
View Author and Article Information

Dr. Mangurian, Ms. Giwa, Dr. Shumway, and Dr. Dilley are affiliated with San Francisco General Hospital (SFGH) and the Department of Psychiatry, University of California, San Francisco (UCSF). Dr. Fuentes-Afflick is with the Department of Pediatrics and the Department of Epidemiology and Biostatistics, UCSF. Dr. Pérez-Stable is with the Division of General Internal Medicine, Department of Medicine, UCSF. Dr. Schillinger is with the UCSF Division of General Internal Medicine at SFGH. Send correspondence to Dr. Mangurian, Department of Psychiatry, University of California, San Francisco, 1001 Potrero Ave., Suite 7M, San Francisco, CA 94110 (e-mail: christina.mangurian@ucsf.edu).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  The purpose of this study was to evaluate attitudes of primary care providers toward barriers to metabolic monitoring and to characterize their beliefs about providers’ responsibility for monitoring and reducing cardiovascular risk for people with severe mental illness.

Methods  An anonymous survey was administered to 214 primary care providers working in 23 public community health clinics in San Francisco.

Results  The response rate was 77% (164 of 214). Nearly 40% of primary care providers were unaware of consensus guidelines for metabolic monitoring of people who take second-generation antipsychotic medications. Responses showed variation in providers’ beliefs about who should monitor patients’ metabolic risk. The major barriers to metabolic monitoring were severity of psychiatric illness, difficulty collaborating with psychiatrists, and difficulty arranging psychiatric follow-up.

Conclusions  Primary care providers believed that better communication between primary care providers and psychiatrists would facilitate metabolic monitoring and promote better treatment for patients with severe mental illness who are taking antipsychotic medications.

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Anchor for Jump
Table 1Barriers to metabolic screening of people with severe mental illnessa
Table Footer Note

a According to 5% or more of 148 primary care providers surveyed

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References

Colton  CW;  Manderscheid  RW:  Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states.  Preventing Chronic Disease 3:A42, 2006
[PubMed]
 
Brown  S;  Kim  M;  Mitchell  C  et al:  Twenty-five year mortality of a community cohort with schizophrenia.  British Journal of Psychiatry 196:116–121, 2010
[CrossRef] | [PubMed]
 
Druss  BG:  Improving medical care for persons with serious mental illness: challenges and solutions.  Journal of Clinical Psychiatry 68(suppl 4):40–44, 2007
[CrossRef] | [PubMed]
 
McEvoy  JP;  Meyer  JM;  Goff  DC  et al:  Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III.  Schizophrenia Research 80:19–32, 2005
[CrossRef] | [PubMed]
 
Newcomer  JW;  Hennekens  CH:  Severe mental illness and risk of cardiovascular disease.  JAMA 298:1794–1796, 2007
[CrossRef] | [PubMed]
 
Nasrallah  HA;  Meyer  JM;  Goff  DC  et al:  Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline.  Schizophrenia Research 86:15–22, 2006
[CrossRef] | [PubMed]
 
American Diabetes AssociationAmerican Psychiatric AssociationAmerican Association of Clinical Endocrinologists,  Consensus development conference on antipsychotic drugs and obesity and diabetes.  Diabetes Care 27:596–601, 2004
[CrossRef] | [PubMed]
 
Buckley  PF;  Miller  DD;  Singer  B  et al:  Clinicians’ recognition of the metabolic adverse effects of antipsychotic medications.  Schizophrenia Research 79:281–288, 2005
[CrossRef] | [PubMed]
 
Essock  SM;  Covell  NH;  Leckman-Westin  E  et al:  Identifying clinically questionable psychotropic prescribing practices for Medicaid recipients in New York State.  Psychiatric Services 60:1595–1602, 2009
[CrossRef] | [PubMed]
 
Morrato  EH;  Druss  B;  Hartung  DM  et al:  Metabolic testing rates in 3 state Medicaid programs after FDA warnings and ADA/APA recommendations for second-generation antipsychotic drugs.  Archives of General Psychiatry 67:17–24, 2010
[CrossRef] | [PubMed]
 
Morrato  EH;  Cuffel  B;  Newcomer  JW  et al:  Metabolic risk status and second-generation antipsychotic drug selection: a retrospective study of commercially insured patients.  Journal of Clinical Psychopharmacology 29:26–32, 2009
[CrossRef] | [PubMed]
 
Arbuckle  MR;  Gameroff  MJ;  Marcus  SC  et al:  Psychiatric opinion and antipsychotic selection in the management of schizophrenia.  Psychiatric Services 59:561–565, 2008
[CrossRef] | [PubMed]
 
Olfson  M;  Marcus  SC;  Wilk  J  et al:  Awareness of illness and nonadherence to antipsychotic medications among persons with schizophrenia.  Psychiatric Services 57:205–211, 2006
[CrossRef] | [PubMed]
 
Amiel  JM;  Pincus  HA:  The medical home model: new opportunities for psychiatric services in the United States.  Current Opinion in Psychiatry 24:562–568, 2011
[PubMed]
 
Parameswaran  SG;  Chang  C;  Swenson  AK  et al:  Roles in and barriers to metabolic screening for people taking antipsychotic medications: a survey of psychiatrists. Schizophrenia Research. 143:395–396, 2013
 
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