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Articles   |    
Monitoring for Metabolic Side Effects Among Outpatients With Dementia Receiving Antipsychotics
Dinesh Mittal, M.D.; Chenghui Li, Ph.D.; Kristen Viverito, Psy.D.; James Silas Williams, B.S.; Reid D. Landes, Ph.D.; Purushottam B. Thapa, M.B.B.S., M.P.H.; Richard Owen, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300317
View Author and Article Information

Except for Dr. Thapa, the authors are with the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (e-mail: dinesh.mittal@va.gov). Dr. Mittal, Dr. Viverito, Dr. Thapa, and Dr. Owen are with the Division of Health Services Research in the Psychiatric Research Institute, Dr. Li is with the Division of Pharmaceutical Evaluation and Policy in the College of Pharmacy, and Dr. Landes is with the Department of Biostatistics, all at the University of Arkansas for Medical Sciences, Little Rock. Dr. Thapa is also with the Arkansas State Hospital, Little Rock.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study examined monitoring for metabolic side effects among older outpatients with dementia starting a new antipsychotic.

Methods  In a retrospective cohort analysis of U.S. Department of Veterans Affairs data, monitoring, as recommended by the American Diabetes Association and the American Psychiatric Association, was examined between October 1, 2005, and September 30, 2011. The sample included outpatients aged ≥60 years with dementia but without a psychotic disorder (N=3,903) and outpatients with a psychotic disorder but without dementia (N=5,779) who were prescribed a new antipsychotic. Because dementia patients differed from psychosis patients in all observed patient characteristics, especially age, metabolic monitoring of dementia patients was compared with a propensity score–matched sample of outpatients with psychosis (1,576 matched pairs).

Results  At baseline (±30 days from the index prescription), 68% of the matched dementia patients were weighed, compared with 63.7% of the matched psychosis patients (odds ratio [OR]=1.28, 95% confidence interval [CI]=1.03–1.48). Monitoring for glucose or glycosylated hemoglobin (HBA1c) and low-density lipoprotein (LDL) was not significantly different between the groups: glucose or HBA1c, 41% versus 44%; LDL, 24% versus 27%. At three months (±30 days), metabolic monitoring for all three parameters was significantly lower for the dementia group: weight, OR=.86, CI=.75–.99; glucose or HBA1c, OR=.83, CI=.71–.97; and LDL, OR=.69, CI=.57–.85.

Conclusions  Monitoring rates for metabolic side effects were low for both dementia and psychosis groups, with lower rates for dementia patients at follow-up compared with matched psychosis patients. Quality improvement efforts are needed to improve monitoring, especially for patients with dementia.

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Table 1Characteristics of VA patients, by diagnostic group and before and after propensity score matching
Table Footer Note

a The p values for unmatched samples were tested using t tests for continuous variables and chi square tests for categorical variables; p values for matched samples were generated using paired t tests for continuous variables and McNemar's test for categorical variables.

Table Footer Note

b Standardized differences are the percentage standardized difference between diagnosis groups by using the formula of Austin and Mamdani (28). A standardized difference of >10 percentage points is considered significant.

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Table 2Baseline and follow-up monitoring of metabolic risk parameters among VA patients, by diagnostic group and before and after propensity score matching
Table Footer Note

a Monitoring was associated with the time point if performed within 30 days before or after the baseline and 3-month follow-up time-point.

Table Footer Note

b Odds ratios (ORs) for matched samples were estimated by using conditional logistic regression with dementia diagnosis as the only predictor.

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