title: Psychiatrists' follow-up of identified metabolic risk: a mixed-method analysis of outcomes and influences on practice.
abstract: Aims and methodTo describe and explain psychiatrists' responses to metabolic abnormalities identified during screening. We carried out an audit of clinical records to assess rates of monitoring and follow-up practice. Semi-structured interviews with 36 psychiatrists followed by descriptive and thematic analyses were conducted.ResultsMetabolic abnormalities were identified in 76% of eligible patients screened. Follow-up, recorded for 59%, was variable but more likely with four or more abnormalities. Psychiatrists endorse guidelines but ambivalence about responsibility, professional norms, resource constraints and skills deficits as well as patient factors influences practice. Therapeutic optimism and desire to be a 'good doctor' supported comprehensive follow-up.Clinical implicationsPsychiatrists are willing to attend to physical healthcare, and obstacles to recommended practice are surmountable. Psychiatrists seek consensus among stakeholders about responsibilities and a systemic approach addressing the social determinants of health inequities. Understanding patients' expectations is critical to promoting best practice.
authors.affiliation: Metro North Mental Health, Queensland, Australia; Griffith University, Queensland, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Patterson
authors.affiliation: Metro North Mental Health, Queensland, Australia.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Freshwater
authors.affiliation: Queensland University of Technology, Queensland, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Goulter
authors.affiliation: Metro North Mental Health, Queensland, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Ewing
authors.affiliation: Metro North Mental Health, Queensland, Australia.
authors.forename: Boyd
authors.initials: B
authors.lastname: Leamon
authors.affiliation: Metro North Mental Health, Queensland, Australia.
authors.forename: Anand
authors.initials: A
authors.lastname: Choudhary
authors.affiliation: Metro North Mental Health, Queensland, Australia.
authors.forename: Vikas
authors.initials: V
authors.lastname: Moudgil
authors.affiliation: Metro North Mental Health, Queensland, Australia; The University of Queensland, Australia.
authors.forename: Brett
authors.initials: B
authors.lastname: Emmerson