title: 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.
authors.affiliation: Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr., Building 58 (152/NLR), North Little Rock, AR 72114, USA. dinesh.mittal@va.gov
authors.forename: Dinesh
authors.initials: D
authors.lastname: Mittal
authors.forename: Chenghui
authors.initials: C
authors.lastname: Li
authors.forename: James Silas
authors.initials: JS
authors.lastname: Williams
authors.forename: Kristen
authors.initials: K
authors.lastname: Viverito
authors.forename: Reid D
authors.initials: RD
authors.lastname: Landes
authors.forename: Richard R
authors.initials: RR
authors.lastname: Owen
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects; D016001:Confidence Intervals; D016208:Databases, Factual; D016903:Drug Monitoring; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D014481:United States; D014728:Veterans / Q000523:psychology*
chemical_list: D014150:Antipsychotic Agents; D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin