title: Improving metabolic monitoring in patients maintained on antipsychotics in Penang, Malaysia.
abstract: OBJECTIVE
  To evaluate the monitoring of metabolic parameters among outpatients maintained on antipsychotic medications in a general hospital setting in Malaysia and to assess the impact of a local monitoring protocol.
  
  
  METHODS
  By performing a baseline audit of files from a random sample of 300 patients prescribed antipsychotic medications for at least 1 year; we determined the frequency of metabolic monitoring. The findings informed the design of a new local protocol, on which clinical staff was briefed. We re-evaluated metabolic monitoring immediately after implementation, in a small sample of new referrals and current patients. We explored staff perceptions of the initiative with a follow-up focus group, 6 months post-implementation.
  
  
  RESULTS
  The baseline audit revealed a sub-optimal frequency of metabolic parameter recording. Re-audit, following implementation of the new protocol, revealed improved monitoring but persisting deficits. Dialogue with the clinical staff led to further protocol modification, clearer definition of staff roles and use of a standard recording template. Focus group findings revealed positive perceptions of the initiative, but persisting implementation barriers, including cultural issues surrounding waist circumference measurement.
  
  
  CONCLUSIONS
  Responding to challenges in achieving improved routine metabolic monitoring of patients maintained on antipsychotics required on-going dialogue with the clinical staff, in order to address both service pressures and cultural concerns.
authors.affiliation: 3rd Year Medical Student, School of Medicine and Medical Sciences, University College Dublin (UCD), Belfield, Dublin, Ireland.
authors.forename: Esther Sl
authors.initials: ES
authors.lastname: Hor
authors.affiliation: Research Officer, Penang General Hospital, Penang, Malaysia.
authors.forename: Sivasangari
authors.initials: S
authors.lastname: Subramaniam
authors.affiliation: Lecturer, Department of Pre-University Studies, Disted College, Penang, Malaysia.
authors.forename: Jun Min
authors.initials: JM
authors.lastname: Koay
authors.affiliation: Associate Professor, Department of Psychiatry, Penang Medical College, Penang, Malaysia.
authors.forename: Arokiamary
authors.initials: A
authors.lastname: Bharathy
authors.affiliation: Senior Lecturer, Department of Psychiatry, Penang Medical College, Penang, Malaysia.
authors.forename: Umadevi
authors.initials: U
authors.lastname: Vasudevan
authors.affiliation: Senior Lecturer, Department of Psychiatry, Penang Medical College, Penang, Malaysia.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Panickulam
authors.affiliation: Consultant Psychiatrist, Penang General Hospital, Penang, Malaysia.
authors.forename: InnTiong
authors.initials: I
authors.lastname: Ng
authors.affiliation: Clinical Director, Department of Psychiatry, Penang General Hospital, Penang, Malaysia.
authors.forename: Nor Hayati
authors.initials: NH
authors.lastname: Arif
authors.affiliation: Honorary Clinical Associate Professor, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland vincentrussell@rcsi.ie.
authors.forename: Vincent
authors.initials: V
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D054869:Clinical Audit; D005260:Female; D017144:Focus Groups; D006801:Humans; D008296:Malaysia; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism*; D024821:Metabolic Syndrome / Q000175:diagnosis*; D008875:Middle Aged; D010045:Outpatients; D012307:Risk Factors; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Malaysia; antipsychotic agents; cultural issues; mental disorders; metabolic monitoring; metabolic syndrome; patient monitoring; staff behaviour; waist circumference