1. Evaluation of lipid and glucose monitoring after implementation of a pharmacist initiated antipsychotic monitoring form. Erin McCleeary Monthei, Pharm.D. 1 & Eric C. Kutscher, Pharm.D., BCPP 1,2 1 Avera Behavioral Health Center, 2 South Dakota State University College of Pharmacy Methods Design A retrospective chart review will be completed on patients meeting inclusion criteria. Data Collection Background characteristics Medication information Antipsychotic(s) Start/stop date of medications Date of last lipid panel and/or glucose or A1c at an Avera Facility Inclusion/exclusion criteria Patients age 18-65 years old admitted to an adult behavioral health unit on at least one scheduled antipsychotic. Patients were excluded if they were hospitalized less than 48 hours, pregnant, residents of a correctional facility. Based on the time periods chosen for study and Avera Behavioral Health’s formulary, lurasidone was not included in the analysis. Patients were not included in analysis if the antipsychotic was stopped during hospitalization. Implementation The study was approved by the Avera Institutional Review Board as an exempt project. The unit pharmacist is responsible for evaluating patients on a scheduled antipsychotic and placing a completed metabolic monitoring form in the chart. Data was collected From April and November 2011 The primary investigator preformed all chart review and assessed for adherence and appropriateness of glucose and lipid panel orders. Data Management and Analysis Data was entered into a secure database and exported into SAS version 9.2 for analysis Fisher’s exact tests and Mann Whitney Wilcoxon tests were used for data analysis. Background Patients with mental illness have a decreased life expectancy with the majority of premature deaths being related to cardiovascular events. 1,2 Patients of public mental health clinics had a shorter life expectancy of 13-30 years. 3 Antipsychotics are associated with metabolic effects including increased body weight, cholesterol, and glucose. In 2004, the American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologist, and North American Association for the Study of Obesity released consensus guidelines (ADA/APA guidelines) for monitoring with second generation antipsychotics. 4 Adherence to guidelines has been found to be low in previous studies. - Adherence to baseline glucose testing varies from 19-38.9%. 5,6,7,8 - Adherence to baseline lipid monitoring was found to be between 6-24.5%. 5,6,7,8 - In a single study, only 5% of patients had both baseline glucose and lipid testing. 5 References 1.Newcomer JW, Hennekens CH. Severe mental illness and risk of cardiovascular disease. J Am Med Assoc. 2007;298:1794-6. 2.Viron MJ, Stern TA. The impact of serious mental illness on health and healthcare. Psychosomatics. 2010;51:458-64. 3.Colton CW, Manderscheid RW. Congruencies in increased mortality rate, years of potential life lost, and causes of death among public health clients in eight states. Prev Chronic Dis [serial online]. 2006;3. Available at: http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm. Accessed August 18, 2011. 4.American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity: Consensus development conference on antipsychotics drugs and obesity and diabetes. Diabetes Care. 2004;27:596-601. 5.Morrato EH, Newcomer JW, Allen RR, Valuck RJ. Prevalence of baseline serum glucose and lipid testing in users of second- generation antipsychotic drugs: a retrospective, population- based study of medicaid claims data. J Clin Psychiatry. 2008;69:316-22. 6.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. Arch Gen Psychiatry. 2010;67:17-24. 7.Barnett M, VonMuenster S, Wehring H, et al. Assessment of monitoring for glucose and lipid dysregulation in adult Medi-Cal patients newly started on antipsychotics. Ann Clin Psychiatry. 2010;22:9-17. 8.Haupt DW. Rosenblatt LC, Kim E, Baker RA, Whitehead R, Newcomer JW. Prevalence and predictors of lipid and glucose monitoring in commercially insured patients treated with second- generation antipsychotic agents. Am J Psychiatry. 2009;166:345-53. Statement of the Problem Monitoring for metabolic effects of antipsychotics according to recommendations by the ADA/APA guidelines has been shown to be <40% in several studies. Currently there is a lack of data on ways to increase adherence to these guidelines on an inpatient basis. Preliminary Results Preliminary results are for patients started on an antipsychotic during admission (baseline monitoring). Age, race, days on antipsychotic, length of stay, and co morbidities were included in the preliminary analysis - In the pre-intervention group, patients with schizophrenia were significantly more likely to have baseline lipid monitoring (p=0.0418). - In the post-intervention group and in combined data, patients with a diagnosis of diabetes were more likely to have baseline lipid and glucose/A1c monitoring ( p=,0.0475, p=0.0496). - All other results were not statistically significant. Primary Objective To determine if the metabolic monitoring form for antipsychotics initiated by pharmacists improves adherence to ADA/APA guidelines in an inpatient psychiatric population. Secondary Objective To determine what factors may affect adherence to the ADA/APA guidelines for patients on scheduled antipsychotics. Disclosure and Acknowledgements The authors of this presentation have no possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation. We would like to thank the Avera Behavioral Health Center pharmacists for their support in implementation of the metabolic monitoring form and Aireen Guzman for her assistance in statistical analysis.Pre-Intervention(n=33) Post –Intervention (n=30)Total(n=63) Sex* Male Female 16 (48%) 17 (52%) 11 (37%) 19 (63%) 27 (43%) 36 (57%) Race/Ethnicity Caucasian Native American Other 28 (85%) 2 (6%) 3 (9%) 27 (90%) 2 (7%) 1 (3%) 55 (87%) 4 (6%) Discharge Diagnosis† Depression Schizophrenia Bipolar Psychosis 12 (36%) 7 (21%) 9 (27%) 13 (39%) 12 (40%) 6 (20%) 10 (33%) 5 (17%) 24 (38%) 13 (21%) 19 (30%) 18 (29%) Comorbidites Diabetes Hyperlipidemia 4 (12%) 2 (6%) 4 (13%) 8 (13%) 6 (10%) Antipsychotic* Aripiprazole Fluphenazine Haloperidol Olanzapine Perphenazine Quetiapine Risperidone Ziprasidone 4 (12%) 1 (3%) 3 (9%) 7 (21%) 0 (0%) 8 (24%) 2 (6%) 8 (27%) 0 (0%) 2 (7%) 6 (20%) 1 (3%) 3 (10%) 10 (33%) 0 (0%) 12 (19%) 1 (2%) 5 (8%) 13 (21%) 1 (2%) 11 (17%) 18 (29%) 2 (3%) Average Length of Stay (days) 9.2 Average Age (years)35,740.137.9 Average time on antipsychotic during hospitalization (days) 6.95.66.3 Demographics Comparison of Monitoring Rates Pre- and Post-Intervention Preliminary Conclusions Lipid and glucose/A1c baseline monitoring rates were found to be higher than previously published rates pre- and post-analysis. Post-intervention rates of baseline monitoring increased; however, the increase was not statistically significant. Additional studies are needed to determine why providers are not adhering to ADA/APA guidelines and if other interventions would be more effective. * Analysis in process †Percentages do not add up to 100% as many patients had more than one diagnosis at discharge Metabolic Monitoring Form