Monitoring and management of metabolic abnormalities: mixed-method evaluation of a successful intervention.
OBJECTIVE
To describe the process and impact of a service-level intervention on metabolic monitoring and follow-up of patients of a mental health service who were prescribed clozapine, and describe the metabolic health of these patients.


METHODS
The intervention - Let's Get Physical - involved designating two months annually as 'physical health months', during which revised service protocol required metabolic monitoring for all eligible patients. Mixed methods were used to assess rates of monitoring at baseline, during the two physical health months, and follow-up and factors influencing practice. Data was analysed using a descriptive statistics and framework approach.


RESULTS
Monitoring was completed for around two thirds of eligible patients during each physical health month, representing a statistically significant increase (approximately fourfold) from baseline. Perceptions regarding scope of practice and perceived competency managing metabolic abnormalities were key determinants of clinicians' practice. Low rates and inconsistency of follow-up were observed.


CONCLUSIONS
Let's Get Physical is cost effective in enhancing adherence to monitoring guidelines. The use of clinical algorithms supporting timely response to abnormalities should be considered. Ongoing education, role clarity and dedicated resources are required if psychiatrists are to contribute meaningfully to improving the physical health of people with mental illness.
Psychiatric Registrar, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Eleanor
E
Wilson
Psychiatric Registrar, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Christopher
C
Randall
Principal Research Fellow, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia susan_patterson@health.qld.gov.au.
Sue
S
Patterson
Executive Director, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, and University of Queensland, Brisbane, QLD, Australia.
Brett
B
Emmerson
Clinical Director, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Vikas
V
Moudgil
Senior Lecturer, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia and; Imperial College London, Centre for Mental Health, London, UK.
Tim
T
Weaver
antipsychotics; intervention; metabolic; monitoring; physical health