title: Targeted intervention to improve monitoring of antipsychotic-induced weight gain and metabolic disturbance in first episode psychosis.
abstract: OBJECTIVE
  International guidelines recommend monitoring for weight gain and metabolic disturbance in patients prescribed second generation antipsychotics. We aimed to investigate whether a targeted intervention could improve levels of monitoring in a first episode psychosis clinic.
  
  
  METHODS
  A pre-intervention audit of both metabolic screening rates and specific monitoring of weight and metabolic indices following the initiation of antipsychotic medication was performed in our first episode psychosis clinic. This was repeated 18 months later, following an intervention that included a number of targeted improvement strategies based on an analysis of barriers and enablers to performing monitoring within the clinic. The intervention included provision of monitoring equipment, interactive educational events, reminders and prompts and embedding processes for monitoring within team structure.
  
  
  RESULTS
  There were significant improvements in both the screening of metabolic indices and the monitoring of indices following initiation of antipsychotic medications. There were also improvements in the number of active interventions offered to clients by clinicians. However, the level of guideline concordant monitoring remains low within our service.
  
  
  CONCLUSIONS
  A comprehensive programme of implementation strategies can improve both screening and monitoring of the metabolic side-effects of antipsychotic medications. Further focused strategies are necessary to continue to improve monitoring to guideline concordant levels.
authors.affiliation: Orygen Youth Health, 35 Poplar Road, Parkville, Victoria 3052 , Australia. andy.thompson@mh.org.au
authors.forename: Andrew
authors.initials: A
authors.lastname: Thompson
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hetrick
authors.forename: Mario
authors.initials: M
authors.lastname: Alvarez-Jiménez
authors.forename: Alexandra G
authors.initials: AG
authors.lastname: Parker
authors.forename: Michaela
authors.initials: M
authors.lastname: Willet
authors.forename: Frank
authors.initials: F
authors.lastname: Hughes
authors.forename: Maria
authors.initials: M
authors.lastname: Gariup
authors.forename: David Lopez
authors.initials: DL
authors.lastname: Gomez
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight / Q000139:chemically induced*; D011618:Psychotic Disorders / Q000188:drug therapy*; D015430:Weight Gain / Q000187:drug effects*
chemical_list: D014150:Antipsychotic Agents