Monitoring Veterans for Metabolic Side Effects When Prescribing Antipsychotics

Abstract

OBJECTIVE: This study examined practices for monitoring metabolic side effects of antipsychotics at 32 Veterans Affairs (VA) facilities. METHODS: This retrospective cohort analysis included outpatients receiving a new antipsychotic prescription from April 2008 through March 2009 in Veterans Integrated Service Networks 18–22 (N=12,009). Data from national and regional VA data sources were used to examine the extent to which weight, glucose (or hemoglobin A1c), and low-density lipoprotein (LDL) cholesterol were monitored within 30 days of the new prescription (baseline) and 60–120 days thereafter, consistent with American Diabetes and American Psychiatric Association consensus recommendations. Repeated-measures analysis using the generalized estimating equation for binary variables examined the association of patient characteristics with likelihood of monitoring. RESULTS: Monitoring of the three metabolic parameters was significantly greater at baseline than at follow-up (p<.001). Weight was the most frequently monitored parameter. Having a diagnosis of diabetes or dyslipidemia was significantly associated with greater monitoring rates. Although monitoring rates did not vary significantly by psychiatric diagnosis, patients without a psychiatric diagnosis were less likely to be monitored than those with schizophrenia. Compared with patients taking antipsychotics with the lowest metabolic risk, those taking high-risk antipsychotics were more likely to have weight monitored at baseline (adjusted odds ratio [AOR]=1.20), whereas patients prescribed medium-risk antipsychotics were more likely to be monitored at baseline for glucose (AOR=1.12) and LDL (AOR=1.11). CONCLUSIONS: Efforts to improve monitoring of antipsychotics' metabolic side effects are needed and should be applied for all patients regardless of diagnosis.