Psychiatric patients are often vulnerable physically, and studies show low rates of monitoring for side effects in patients taking second-generation antipsychotics (SGAs). Leigh Powers, DNP, MSN, East Tennessee State University, Johnson City, Tennessee, USA, presented the results of a study that used an online survey and interviews to investigate the barriers to monitoring patients for the side effects of SGAs.

One recent study comprising > 10 000 psychiatric outpatients from 219 sites reported a substantial number of patients with cardiometabolic risk factors and/ or metabolic syndrome (MetS) (ie, 27% of patients were overweight, 51% had elevated triglycerides, and 52% of fasting patients met the criteria for MetS), which in many cases were not being treated [Correll CU et al. Psychiatr Serv. 2010]. Many of these patients are prescribed SGAs, which are known to be associated with significant metabolic risks. Despite the availability of guidelines for monitoring side effects, several studies have shown low rates of screening [Wiechers IR et al. Acad Psychiatry. 2012; Morrato EH et al. Arch Gen Psychiatry. 2010; Amiel JM et al. Curr Opin Psychiatry. 2008].

Participants were members of the American Psychiatric Nurses Association's Member Bridge and Tennessee Nurses Association, as well as providers at Frontier Health and East Tennessee State University nurse-managed clinics; they were queried as to their age, ethnicity, race, sex, professional designation, specialty, practice setting, years practicing, and frequency of and comfort level with prescribing SGAs. Survey questions assessed their knowledge of and compliance and agreement with the monitoring guidelines and the ease vs difficulty of monitoring due to patient, systems, or insurance issues. At the end of the survey, participants were asked to provide an e-mail address if they were interested in participating in a follow-up interview. Sample size for the interviews was determined by data saturation (ie, when no new themes emerged).

Approximately 80% of participants were nurse practitioners, and about 15% were doctors (of medicine or osteopathic medicine); the remainder were either clinical nurse specialists or other. Between 30% and 40% of respondents reported a high comfort level in prescribing psychotropic medications; the comfort level was moderate in about 50%.

Four major interview themes emerged: insufficient collaborative care, lack of knowledge, limited patient encounter time, and patient nonadherence to completing the requested laboratory studies. Participants were presented with 9 possible barriers and asked to rate how likely each was to affect their implementation of metabolic monitoring in their practice, using a scale of 1 to 5 (1, no significance; 5, very significant; Figure 1). The highest rating (∼3.5) was given to “severity of psychiatric and/or medical illness”; the lowest (< 2.25) was given to “limited organizational support.”

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Figure 1.

Barriers to Implementing Side Effect Monitoring in Patients Taking Second-Generation Antipsychotics

Ratings are on scale of 1 to 5; 1 is no significance, 5 is very significant.Reproduced with permission from L Powers, DNP, MSN.

To improve the quality of care for these patients, providers need to continue education and review of the existing guidelines as well as have more open, interprofessional dialogue. Systems changes, such as improved scheduling and staffing, are also needed, as is an increase in the availability of psychiatric services using the medical home model.