title: A case control study of the implementation of change model versus passive dissemination of practice guidelines for compliance in monitoring for metabolic syndrome.
abstract: We developed an intervention to improve compliance with guidelines for monitoring metabolic syndrome and compared compliance prior to intervention and three times post-intervention at three community mental health clinics in Texas. One test clinic received intervention and two other clinics served as controls. Fifty random charts were reviewed from each clinic for three specific, 1-2 weeks periods over the course of 18 months. There were significant improvements in the ordering of labs, the presence of lab results in the chart, and documentation of blood pressure, body mass index and waist circumference in the intervention clinic over time in comparison to the control clinics. Documented evidence of physician action with respect to out of range values remained low. Metabolic monitoring is a multi-step process. Removing barriers, creating specific procedures, and dedicating staff resources can improve compliance with monitoring.
authors.affiliation: Department of Psychiatry, University of Texas Health Science Center-San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA. velligand@uthscsa.edu
authors.forename: Dawn I
authors.initials: DI
authors.lastname: Velligan
authors.forename: Desiree
authors.initials: D
authors.lastname: Castillo
authors.forename: Linda
authors.initials: L
authors.lastname: Lopez
authors.forename: Bren
authors.initials: B
authors.lastname: Manaugh
authors.forename: Charlotte
authors.initials: C
authors.lastname: Davis
authors.forename: Juanita
authors.initials: J
authors.lastname: Rodriguez
authors.forename: A Camis
authors.initials: AC
authors.lastname: Milam
authors.forename: Albana
authors.initials: A
authors.lastname: Dassori
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Miller
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure; D016022:Case-Control Studies; D003156:Community Mental Health Services / Q000379:methods / Q000458:organization & administration*; D004059:Diffusion of Innovation; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008499:Medical Records; D001523:Mental Disorders / Q000188:drug therapy; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013781:Texas; D055105:Waist Circumference
chemical_list: D018687:Antidepressive Agents, Second-Generation