Screening for the metabolic syndrome in community psychiatric patients prescribed antipsychotics: a quality improvement programme

• Published in: Acta psychiatrica Scandinavica Vol. 118; no. 1; pp. 26 - 33
• Main Authors: Barnes, T. R. E., Paton, C., Hancock, E., Cavanagh, M.-R., Taylor, D., Lelliott, P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2008; Blackwell
• Subjects: Adolescent; Adult; Aged; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; antipsychotics; Benchmarking - standards; Biological and medical sciences; Body Weight - drug effects; Community Mental Health Services - standards; Community-Institutional Relations - standards; Dose-Response Relationship, Drug; Drug Therapy, Combination; Drug toxicity and drugs side effects treatment; England; Female; Health Services Accessibility; Humans; Life Style; Male; Mass Screening - standards; Medical Audit - standards; Medical sciences; Medical screening; Mental disorders; Metabolic syndrome; Metabolic Syndrome - chemically induced; Metabolic Syndrome - diagnosis; Metabolic Syndrome - epidemiology; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Mood Disorders - drug therapy; Mood Disorders - epidemiology; Pharmacology. Drug treatments; Physical Examination; Psychiatry; Psychotic Disorders - drug therapy; Psychotic Disorders - epidemiology; Quality Assurance, Health Care - standards; Quality Indicators, Health Care - standards; Quality of care; Reference Standards; Reminder Systems; Retrospective Studies; screening; Surveys and Questionnaires; United Kingdom; Europe; United Kingdom > UK; Endocrinopathy; Social environment; Human; Sanitary program; screening; Psychotropic; Neuroleptic; Toxicity; Mental health; Pharmacotherapy; Metabolic diseases; Cardiovascular disease; Medical screening; Metabolic syndrome; Audit; Treatment; Follow up study; Mental disorder; antipsychotics; Community treatment; Public health
• ISSN: 0001-690X; 1600-0447; 1600-0447
• DOI: 10.1111/j.1600-0447.2008.01203.x

Objective:  The aim was to evaluate a quality improvement programme designed to increase screening for the metabolic syndrome in community psychiatric patients prescribed antipsychotics. Method:  Baseline audit against evidence‐based standards, followed by provision of benchmarked data and a range of change interventions, with re‐audit 1 year later. Results:  At baseline, 48 assertive outreach teams across the UK submitted data on screening over the previous year for 1966 patients. At re‐audit, 35 of the teams submitted data for 1516 patients. Screening for all four aspects of the metabolic syndrome (measuring blood pressure, obesity, blood glucose and plasma lipids) had increased significantly by re‐audit. Clinical variables increasing the likelihood of full screening were clozapine treatment and a known diagnosis of diabetes or dyslipidaemia. Conclusion:  The programme’s success may be partly attributed to the use of a widely‐accepted audit standard, and bespoke change interventions that directly addressed barriers to screening identified by the participating clinical teams.