Wednesday, April 19, 2017

Few Child Psychiatrists Follow Guidelines for Metabolic Monitoring of Youth on SGAs

Few child psychiatrists monitor children treated with second-generation antipsychotics (SGAs) in accordance with treatment guidelines, even though most are aware of those guidelines and agree with them, according to a survey published Monday in Psychiatric Services in Advance.

“The low rate of monitoring, despite high levels of awareness of and agreement with the need to monitor, suggests that obstacles interfere with adopting these guidelines,” Jennifer L. McLaren, M.D., of Dartmouth-Hitchcock Medical Center and colleagues wrote. The findings of the survey suggest family resistance to monitoring may be one such barrier to compliance.

Youth treated with SGAs are known to be at a greater risk of weight gain, developing type II diabetes, and elevated cholesterol. In 2004, APA and the American Diabetes Association published guidelines on screening and monitoring of patients on SGAs, which were endorsed by the American Academy of Child and Adolescent Psychiatry (AACAP) in 2011. The guidelines specify routine monitoring of fasting blood glucose, fasting lipid profiles, body mass index (BMI), and abnormal involuntary movements (AIMs) prior to and periodically after initiating SGAs.

McLaren and colleagues sent the survey to 4,144 working email addresses of child psychiatrists throughout the United States who were registered members of the AACAP, excluding psychiatrists in training, between December 2012 and February 2013.

Among responders (N=1,314, 32%), over 95% were aware of the guidelines for monitoring children and adolescents on SGAs. Fewer respondents agreed with the recommendations, with agreement rates ranging from 69% for fasting lipids to 80% for glucose, 89% for AIMs, and 91% for BMI monitoring. Less than 20% had adopted and adhered to most guidelines.

Additional analysis revealed that psychiatrists who were in academic practice had greater monitoring of glucose, lipids, BMI, and AIMs. In contrast, a physician’s length of time in practice was inversely related to monitoring glucose, lipids, and BMI. Many of the psychiatrists surveyed (82%) reported that parents who forget to obtain laboratory tests were a barrier to obtaining fasting glucose and lipids. Other commonly cited barriers were parental resistance (52%) and children’s refusal to obtain the tests (63%).

“Potential interventions to improve adoption include education with audit and feedback directed at specific providers who have not adopted recommended monitoring practices, monitoring reminder systems, and family education to improve knowledge and attitudes about monitoring,” the authors wrote.

For related information, see the Psychiatric News article “Recent Rise in Youth on Antipsychotics Raises Concerns Among Experts.”

(Image: iStock/Jovanmandic)


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