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Comparison of Strategies to Improve Antipsychotic Monitoring and Management For Schizophrenia

Comparison of Strategies to Improve Antipsychotic Monitoring and Management For Schizophrenia. Richard R. Owen, MD Jeffrey L. Smith, PhD(c) Teresa J. Hudson, PharmD Geoffrey M. Curran, PhD

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Comparison of Strategies to Improve Antipsychotic Monitoring and Management For Schizophrenia

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  1. Comparison of Strategies to Improve Antipsychotic Monitoring and Management For Schizophrenia Richard R. Owen, MD Jeffrey L. Smith, PhD(c) Teresa J. Hudson, PharmD Geoffrey M. Curran, PhD Mental Health Quality Enhancement Research Initiative (QUERI)Center for Mental Healthcare & Outcomes ResearchCentral Arkansas Veterans Healthcare System Funding: VA HSR&D MNT 02-215

  2. Background • Schizophrenia highly disabling and burdensome in VA • 1.3% prevalence; over 90,000 veterans treated annually • Patients w/ schizophrenia account for 12% of annual VA healthcare costs • Antipsychotic medications are a key component of treatment • Many antipsychotics cause metabolic abnormalities • Weight gain • Diabetes • Dyslipidemia • Recommendations for metabolic monitoring are not followed

  3. AStudy of Strategies to Improve Schizophrenia Treatment (ASSIST) • Objectives: Develop and test intervention strategies/tools to increase adherence to VA guidelines on… • antipsychotic dosing and side effect monitoring • Reduce use of very high antipsychotic doses • >125% of recommended dose range • Limited evidence for efficacy • Increase baseline monitoring for metabolic side effects associated with antipsychotics • Focus on weight gain, diabetes onset, hyperlipidemia

  4. ASSIST Design / Methods • Ten VAMC sites across 4 VISNs participating • Quasi-experimental design • Six sites in dosing and metabolic monitoring arm • Four sites in clozapine arm • Compare change strategies • Team Quality Improvement • Opinion Leader • Usual Care

  5. ASSIST Tools and Strategies • Educational tools (for clinicians and patients) • Clinical support tools • Pocket-sized booklet with dosing and side effect monitoring recommendations • CPRS clinical reminder for SE monitoring • Performance monitoring tools (VISTA data) • Monthly site performance reports • Weekly provider-specific feedback on side effect monitoring • Facilitated Team QI vs. Opinion Leader strategies

  6. Results – Weight Monitoring (VISN A)

  7. Results – Weight Monitoring (VISN B)

  8. Results – Glucose Monitoring (VISN A)

  9. Results – Glucose Monitoring (VISN B)

  10. Effective QI Components • Computer routine to identify patients due for monitoring • Designating a provider or clinic to ensure that monitoring occurred • Team site – designated team member to review weekly reports and contact providers • Opinion Leader site – established clinic to perform baseline monitoring • Leadership support • VISN performance measures for SE monitoring

  11. Team Site - Antipsychotic Side Effect Monitoring Weekly reports implemented

  12. Discussion • Facilitated QI strategies can improve metabolic side effect monitoring • Specific implementation steps (weekly reports, follow-up process) more important than implementation strategy (team QI vs. opinion leader) • Future research is need to test dissemination of effective strategies

  13. Limitations • Multiple case study design • One site randomized to Team QI had initial site visit but never began implementation phase of study

  14. QUESTIONS? Contact: Rick Owen Center for Mental Healthcare & Outcomes Research E-mail: Richard.Owen2@va.gov

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