Magazine article Clinical Psychiatry News

Disparity Cited on Metabolic Testing

Magazine article Clinical Psychiatry News

Disparity Cited on Metabolic Testing

Article excerpt

CHICAGO -- A great disparity exists between psychiatrists' professed high rates of guideline-recommended cardiometabolic monitoring of patients on second-generation antipsychotic drugs and what they are actually doing as reflected in laboratory billing claims data, studies indicate.

"We consistently see that what's reported as happening is not what we observe when we look at lab claims for blood glucose and lipid testing. In both Medicaid and commercially insured populations, our screening and monitoring rates remain disturbingly low," Elaine H. Morrato, Dr.P.H., said at the American Psychiatric Association's Institute on Psychiatric Services.

Particularly striking is the evidence of extremely low rates of cardiometabolic screening and monitoring in children and adolescents on atypical antipsychotic agents. That's of concern, because the use of these drugs in the pediatric population is growing rapidly, and these young patients are the ones who stand to gain far and away the most in their years of life through effective primary prevention efforts, noted Dr. Morrato of the departments of pediatrics, preventive medicine and biometrics, and clinical pharmacy at the University of Colorado at Denver.

In early 2004, the American Psychiatric Association, the American Diabetes Association, American Association of Clinical Endocrinologists, and North American Association for the Study of Obesity issued consensus guidelines on cardiometabolic monitoring of patients on antipsychotic drugs (Diabetes Care Feb. 2004;27:596-601).

A survey of 500 randomly selected U.S. psychiatrists conducted almost 2 years later found a high degree of awareness of the problem of premature mortality because of cardiovascular causes and diabetes in patients with major mental illness. Of that group, 94% viewed metabolic syndrome as a significant health problem. In addition, 78% reported monitoring body weight in most or all of their patients during treatment. And 69% indicated that they routinely monitor fasting blood glucose; 61% monitor lipids; and 52%, blood pressure (Psychopharmacol. Bull. 2007;40:22-37).

Those numbers are far higher than were seen in psychiatrist surveys done before the guidelines were instituted. But the rates do not match what Dr. Morrato and others are finding in large billing databases.

For example, Dr. Morrato and her colleagues recently studied laboratory claims data for more than 18,000 adults in a commercially insured database who started on a second-generation antipsychotic drug in 2001-2006. …

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